Provider Demographics
NPI:1073862892
Name:DANA LANE
Entity Type:Organization
Organization Name:DANA LANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-240-5769
Mailing Address - Street 1:2108 W FORE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5005
Mailing Address - Country:US
Mailing Address - Phone:813-240-5769
Mailing Address - Fax:813-932-2588
Practice Address - Street 1:14502 N DALE MABRY HWY
Practice Address - Street 2:SUITE 200-52
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2075
Practice Address - Country:US
Practice Address - Phone:813-240-5769
Practice Address - Fax:813-932-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002664200Medicaid