Provider Demographics
NPI:1629384375
Name:LANE, DATHAN J (BS)
Entity Type:Individual
Prefix:MR
First Name:DATHAN
Middle Name:J
Last Name:LANE
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Gender:M
Credentials:BS
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Mailing Address - Street 1:4040 S TYLER ST
Mailing Address - Street 2:STE 9
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2143
Mailing Address - Country:US
Mailing Address - Phone:253-750-2664
Mailing Address - Fax:253-215-4426
Practice Address - Street 1:4040 S TYLER ST
Practice Address - Street 2:STE 9
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2143
Practice Address - Country:US
Practice Address - Phone:253-750-2664
Practice Address - Fax:253-215-4426
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2017-11-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health