Provider Demographics
NPI:1619953155
Name:MILLER, LANE DOUBENMIER (MA)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:DOUBENMIER
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LANE'
Other - Middle Name:
Other - Last Name:DOUBENMIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 MAIN ST
Mailing Address - Street 2:APT. 211
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-1277
Mailing Address - Country:US
Mailing Address - Phone:816-604-8598
Mailing Address - Fax:
Practice Address - Street 1:8801 E 63RD ST
Practice Address - Street 2:SUITE 104
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-4875
Practice Address - Country:US
Practice Address - Phone:816-368-2000
Practice Address - Fax:816-533-6873
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003032247101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497196303Medicaid