Provider Demographics
NPI:1316605678
Name:LANE, JULIA GAYLE (BHT)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:GAYLE
Last Name:LANE
Suffix:
Gender:F
Credentials:BHT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4093 HEART PINE LN
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8511
Mailing Address - Country:US
Mailing Address - Phone:281-886-4040
Mailing Address - Fax:850-452-5269
Practice Address - Street 1:450 TURNER ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-5211
Practice Address - Country:US
Practice Address - Phone:850-452-5642
Practice Address - Fax:850-452-5269
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician