Individual
KEVIN DOUGLAS LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
3100 S NATIONAL AVE STE 103, SPRINGFIELD, MO 65807-7347
(417) 322-6622
(417) 350-1935
Mailing address
3600 S NATIONAL AVE, SPRINGFIELD, MO 65807-7311
(417) 322-6622
(417) 350-1935
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2012037394
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490000328
—
MO
Enumeration date
11/03/2012
Last updated
10/08/2021
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