Provider Demographics
NPI:1619016292
Name:LANE, ELAINE J (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:J
Last Name:LANE
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 KINGS ROW
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4434
Mailing Address - Country:US
Mailing Address - Phone:504-319-8616
Mailing Address - Fax:
Practice Address - Street 1:1242 KINGS ROW
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4434
Practice Address - Country:US
Practice Address - Phone:504-319-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2864101YM0800X
LA888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist