Provider Demographics
NPI:1720155849
Name:LANE, DONALD HENRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:HENRY
Last Name:LANE
Suffix:
Gender:M
Credentials:PHD
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 1346
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-8346
Mailing Address - Country:US
Mailing Address - Phone:817-579-5988
Mailing Address - Fax:817-579-5986
Practice Address - Street 1:708 PALUXY RD STE J
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2396
Practice Address - Country:US
Practice Address - Phone:817-579-5988
Practice Address - Fax:817-579-5986
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1608106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10011014OtherAMERIGROUP
TX00187BOtherBC & BS
TX237345OtherCOMPSYCH
TX7180478OtherAETNA
TX3403815OtherCIGNA BEHAVIORAL HEALTH
TX021710OtherVMC BEHAVIORAL HEALTH