Provider Demographics
NPI:1396034146
Name:LANE, KENTON (MFT)
Entity Type:Individual
Prefix:MR
First Name:KENTON
Middle Name:
Last Name:LANE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 SILVER SPUR RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-4424
Mailing Address - Country:US
Mailing Address - Phone:310-968-1608
Mailing Address - Fax:310-541-5594
Practice Address - Street 1:904 SILVER SPUR RD STE 203
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-4424
Practice Address - Country:US
Practice Address - Phone:310-968-1608
Practice Address - Fax:310-541-5594
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist