Provider Demographics
NPI:1093024655
Name:DAVID, LANE KATHERINE (LPC)
Entity type:Individual
Prefix:MS
First Name:LANE
Middle Name:KATHERINE
Last Name:DAVID
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 REBECCA DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5966
Mailing Address - Country:US
Mailing Address - Phone:337-781-6459
Mailing Address - Fax:
Practice Address - Street 1:600 JEFFERSON ST
Practice Address - Street 2:SUITE 903
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6942
Practice Address - Country:US
Practice Address - Phone:337-412-5102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional