Provider Demographics
NPI:1528207107
Name:LANE, JUSTIN D (BCBA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:D
Last Name:LANE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 HARPETH SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2390
Mailing Address - Country:US
Mailing Address - Phone:615-646-3461
Mailing Address - Fax:
Practice Address - Street 1:3129 HARPETH SPRINGS DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2390
Practice Address - Country:US
Practice Address - Phone:615-646-3461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor