Provider Demographics
NPI:1578737607
Name:DEVEREAUX, LANE (ED S,LMHC)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:
Last Name:DEVEREAUX
Suffix:
Gender:F
Credentials:ED S,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4247
Mailing Address - Country:US
Mailing Address - Phone:352-336-8414
Mailing Address - Fax:
Practice Address - Street 1:1122 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4247
Practice Address - Country:US
Practice Address - Phone:352-336-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5583OtherBLUE CROSS