Provider Demographics
NPI:1225215304
Name:LANE, SHERYL ALEXIS (MA)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:ALEXIS
Last Name:LANE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:SHERYL
Other - Middle Name:ALEXIS
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:309 ISLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333-9712
Mailing Address - Country:US
Mailing Address - Phone:206-300-3923
Mailing Address - Fax:
Practice Address - Street 1:6712 KIMBALL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1212
Practice Address - Country:US
Practice Address - Phone:206-300-3923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00056913101YM0800X
WALF60195211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health