Provider Demographics
NPI:1740465988
Name:LANE, DANA LASHELLE (LMHC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LASHELLE
Last Name:LANE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 W FORE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5005
Mailing Address - Country:US
Mailing Address - Phone:813-240-5769
Mailing Address - Fax:813-932-2588
Practice Address - Street 1:14502 N DALE MABRY HWY
Practice Address - Street 2:SUITE 200-52
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2075
Practice Address - Country:US
Practice Address - Phone:813-240-5769
Practice Address - Fax:813-932-2588
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002664200Medicaid