Provider Demographics
NPI:1770310062
Name:LANE, JASON CLAYTON (LPC, MED)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:CLAYTON
Last Name:LANE
Suffix:
Gender:M
Credentials:LPC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4245
Mailing Address - Country:US
Mailing Address - Phone:304-362-3189
Mailing Address - Fax:
Practice Address - Street 1:123 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4245
Practice Address - Country:US
Practice Address - Phone:304-362-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional