Provider Demographics
NPI:1184322091
Name:LANE, KEVIN (LMHC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:LANE
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 1:2061 NW 21ST TER APT 102
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-8839
Mailing Address - Country:US
Mailing Address - Phone:561-252-4971
Mailing Address - Fax:
Practice Address - Street 1:2061 NW 21ST TER
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-8839
Practice Address - Country:US
Practice Address - Phone:772-208-9454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21630101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health