MEDICARE: MRS. MICHELE MARIE LANEY LMFT

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	106H00000X	Marriage & Family Therapist	1188	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HP 43552	OTHER	MN	HEALTHPARTNERS
2	693 G0AJ	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1811053150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELE MARIE LANEY LMFT

Provider Business Mailing Address
First Line	:	7236 FORESTVIEW LN N
Second Line	:	SUITE 3205
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-5501
Country	:	US
Telephone Number	:	612-419-8461
Fax Number	:	763-425-6597

Provider Business Practice Location Address
First Line	:	7236 FORESTVIEW LN N
Second Line	:	SUITE 3205
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-5501
Country	:	US
Telephone Number	:	612-419-8461
Fax Number	:	763-425-6597

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/08/2007

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