Provider Demographics
NPI:1013074301
Name:MCCONNELL, LANE ALFRED (LMFT)
Entity Type:Individual
Prefix:MR
First Name:LANE
Middle Name:ALFRED
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190424
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33119-0424
Mailing Address - Country:US
Mailing Address - Phone:415-260-4003
Mailing Address - Fax:
Practice Address - Street 1:1337 PENNSYLVANIA AVE APT 5
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-4050
Practice Address - Country:US
Practice Address - Phone:415-260-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46272106H00000X, 172V00000X, 101YA0400X, 174H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No174H00000XOther Service ProvidersHealth Educator