Provider Demographics
NPI:1275820896
Name:LANE, CHE'VUN R (LCDC)
Entity Type:Individual
Prefix:
First Name:CHE'VUN
Middle Name:R
Last Name:LANE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 GUADALUPE ST STE 260
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-5642
Mailing Address - Country:US
Mailing Address - Phone:281-645-0311
Mailing Address - Fax:
Practice Address - Street 1:2025 GUADALUPE ST STE 260
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-5642
Practice Address - Country:US
Practice Address - Phone:218-645-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-03
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)