Individual
DAVID BALLARD LANE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW, LLP, LPC
Contact information
Practice address
1199 HARRIS AVE, TAWAS CITY, MI 48763-9681
(989) 362-8636
Mailing address
1635 DOUGLAS DR, TAWAS CITY, MI 48763-9422
(989) 362-8636
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
6401000213
MI
103T00000X
Psychologist
Primary
6301003884
MI
1041C0700X
Clinical Social Worker
6801016231
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301003884
LLP
MI
01
—
6401000213
LPC
MI
01
—
6801016231
LMSW
MI
Enumeration date
02/08/2007
Last updated
09/11/2025
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