Provider Demographics
NPI:1255928180
Name:LANE, TIMOTHY LEE
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEE
Last Name:LANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 DEER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-9355
Mailing Address - Country:US
Mailing Address - Phone:937-248-6203
Mailing Address - Fax:
Practice Address - Street 1:129 DEER TRAIL DR
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9355
Practice Address - Country:US
Practice Address - Phone:937-248-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor