Provider Demographics
NPI:1417013996
Name:LANE, MICHELE K (LCSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:K
Last Name:LANE
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N BRAESWOOD BLVD STE 224
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-3307
Mailing Address - Country:US
Mailing Address - Phone:713-668-3838
Mailing Address - Fax:713-663-6664
Practice Address - Street 1:6300 WEST LOOP S
Practice Address - Street 2:SUITE 215
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2900
Practice Address - Country:US
Practice Address - Phone:713-668-3838
Practice Address - Fax:713-663-6664
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical