Provider Demographics
NPI:1194770354
Name:LANE, CHRISTINE L (LCPC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:L
Last Name:LANE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W MONROE ST
Mailing Address - Street 2:SUITE 307 MAILBOX 14
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3997
Mailing Address - Country:US
Mailing Address - Phone:309-829-2600
Mailing Address - Fax:
Practice Address - Street 1:200 W MONROE ST
Practice Address - Street 2:SUITE 307 MAILBOX 14
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3997
Practice Address - Country:US
Practice Address - Phone:309-829-2600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional