Individual
JAMES W. LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
6810 STATE ROUTE 162, SUITE 215, MARYVILLE, IL 62062-8501
(618) 288-5711
(618) 288-4088
Mailing address
1836 LACKLAND HILL PKWY, ATTN CREDENTIALING DEPT, SAINT LOUIS, MO 63146-3572
(314) 989-0300
(314) 810-1399
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
IL
Other
Enumeration date
04/06/2007
Last updated
02/19/2008
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