MEDICARE: MARAYAH LANE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1790905263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARAYAH LANE

Provider Business Mailing Address
First Line	:	PO BOX 9092
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93790-9092
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4944 E CLINTON WAY
Second Line	:	SUITE 101
City	:	FRESNO
State	:	CA
Zip	:	93727-1527
Country	:	US
Telephone Number	:	559-251-4800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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Directions to “ MARAYAH LANE ” Practice Location

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