Provider Demographics
NPI:1992386957
Name:DURAN, LANA JANELLE (LSW)
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:JANELLE
Last Name:DURAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W MONROE ST STE C7
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3997
Mailing Address - Country:US
Mailing Address - Phone:217-828-1331
Mailing Address - Fax:
Practice Address - Street 1:407 S FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5627
Practice Address - Country:US
Practice Address - Phone:217-828-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150105053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional