Provider Demographics
NPI:1417660176
Name:LANE, KATHLEEN M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:LANE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:RANDAZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:326 MERRIMAC DOWNS
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7708
Mailing Address - Country:US
Mailing Address - Phone:314-578-3087
Mailing Address - Fax:
Practice Address - Street 1:200 S KINGSHIGHWAY ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1637
Practice Address - Country:US
Practice Address - Phone:314-578-3087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health