Individual
LANA BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHA
Contact information
Practice address
608 HAPPY VALLEY RD, GLASGOW, KY 42141-1561
(270) 901-5000
(270) 842-5268
Mailing address
3387 BRISTOW RD, BOWLING GREEN, KY 42103-9519
(270) 901-5000
(270) 651-9248
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
NO LICENSE
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30604011
—
KY
Enumeration date
10/18/2006
Last updated
07/08/2007
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