Individual
JONATHAN MATHEW LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSS
Contact information
Practice address
1258 HIGH ST, EUGENE, OR 97401-3238
(541) 342-8437
Mailing address
25 SW HOOKER ST, PORTLAND, OR 97201-4747
(503) 922-9174
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
OR
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
—
OR
Other
Enumeration date
01/30/2007
Last updated
06/21/2016
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