Individual
MRS. KIRA C LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC3502
Contact information
Practice address
496 A ST, IDAHO FALLS, ID 83402-3617
(208) 552-7100
(208) 552-7101
Mailing address
217 PINE ST, IDAHO FALLS, ID 83402-4124
(208) 227-6609
(208) 522-8725
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC3502
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010156986
BLUE SHIELD OF IDAHO
ID
01
—
X6889
BLUE CROSS OF IDAHO
ID
Enumeration date
10/17/2006
Last updated
02/21/2008
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