Provider Demographics
NPI:1912632969
Name:LANE, GAYLE ROBIN (LPC)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:ROBIN
Last Name:LANE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 BUTTERFIELD RD STE 101N
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-3405
Mailing Address - Country:US
Mailing Address - Phone:630-586-0900
Mailing Address - Fax:
Practice Address - Street 1:2625 BUTTERFIELD RD STE 101N
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-3405
Practice Address - Country:US
Practice Address - Phone:630-586-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017993101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health