Provider Demographics
NPI:1073847935
Name:LANE, BRANDON S (LCPC)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:S
Last Name:LANE
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9444 SUMMER RAIN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0105
Mailing Address - Country:US
Mailing Address - Phone:702-885-7904
Mailing Address - Fax:
Practice Address - Street 1:7473 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0265
Practice Address - Country:US
Practice Address - Phone:702-706-8096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP0077101YM0800X
NVMI0143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist