Individual
MR. WILLIAM BRADFORD LANE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
409 WASHINGTON AVE, POCATELLO, ID 83201-4520
(208) 234-2646
Mailing address
409 WASHINGTON AVE, POCATELLO, ID 83201-4520
(208) 234-2646
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-6550
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619177797
—
ID
Enumeration date
08/01/2017
Last updated
07/21/2022
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