Individual
JILL DEANNA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, MHC
Contact information
Practice address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 481-2700
(260) 481-2709
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
(260) 266-6013
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39002627A
IN
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
03/09/2009
Last updated
03/15/2021
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