Provider Demographics
NPI:1891357786
Name:OAK LANE COUNSELING
Entity Type:Organization
Organization Name:OAK LANE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:HICKMAN
Authorized Official - Last Name:BENN
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-750-2149
Mailing Address - Street 1:2176 W 250 S UNIT B
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-5541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2972 W MAPLE LOOP DR STE 101B
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5967
Practice Address - Country:US
Practice Address - Phone:801-949-2591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty