Provider Demographics
NPI:1013334754
Name:SANDER, LANE G (LMHC)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:G
Last Name:SANDER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3563 S STATE ROAD 13
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-9162
Mailing Address - Country:US
Mailing Address - Phone:260-563-8453
Mailing Address - Fax:260-569-0335
Practice Address - Street 1:2350 S STATE ROAD 1
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-9698
Practice Address - Country:US
Practice Address - Phone:260-307-5030
Practice Address - Fax:260-824-8445
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health