Provider Demographics
NPI:1023564408
Name:LANE, TONYA L
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:L
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:L
Other - Last Name:RUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 GRANITE RUN DR STE 310
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6821
Mailing Address - Country:US
Mailing Address - Phone:717-617-2065
Mailing Address - Fax:717-824-4862
Practice Address - Street 1:205 GRANITE RUN DR STE 310
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6821
Practice Address - Country:US
Practice Address - Phone:717-617-2065
Practice Address - Fax:717-824-4862
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional