Provider Demographics
NPI:1013071737
Name:LANE, KATRINA G (MS, LPC, LMFT, LSSP)
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:G
Last Name:LANE
Suffix:
Gender:F
Credentials:MS, LPC, LMFT, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5604
Mailing Address - Country:US
Mailing Address - Phone:972-437-4222
Mailing Address - Fax:214-295-6512
Practice Address - Street 1:621 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5604
Practice Address - Country:US
Practice Address - Phone:972-437-4222
Practice Address - Fax:214-295-6512
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12026101YP2500X
TX31818103TS0200X
TX4517106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLP0008996Medicaid