Provider Demographics
NPI:1114911724
Name:LANE, DEBORAH LYNN (MA LPC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:LANE
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:DEBI
Other - Middle Name:LYNN
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 W ELLIOT RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1310
Mailing Address - Country:US
Mailing Address - Phone:480-345-2200
Mailing Address - Fax:480-756-2525
Practice Address - Street 1:1 W ELLIOT RD
Practice Address - Street 2:SUITE 106
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1310
Practice Address - Country:US
Practice Address - Phone:480-345-2200
Practice Address - Fax:480-756-2525
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCC10368101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor