Provider Demographics
NPI:1750398558
Name:LANE, SHELLEY (MFT)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:DUKES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:245M MT HERMON RD.
Mailing Address - Street 2:#101
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066
Mailing Address - Country:US
Mailing Address - Phone:831-461-1951
Mailing Address - Fax:
Practice Address - Street 1:4113 SCOTTS VALLEY DR
Practice Address - Street 2:#212
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4547
Practice Address - Country:US
Practice Address - Phone:831-361-1951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31356106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist