Individual
CORY LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHCA, CDPT
Contact information
Practice address
999 164TH AVE NE, BELLEVUE, WA 98008-3518
(425) 274-8394
Mailing address
110 W RIVMONT DR, MONROE, WA 98272-9737
(301) 367-7550
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CO60788417
WA
101YM0800X
Mental Health Counselor
Primary
MC60831028
WA
Other
Enumeration date
10/16/2018
Last updated
10/16/2018
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