Provider Demographics
NPI:1386101723
Name:LANE, CHERLYN (MA, LMFT)
Entity type:Individual
Prefix:
First Name:CHERLYN
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7006 GOLDEN OAK LN
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5803
Mailing Address - Country:US
Mailing Address - Phone:678-923-8859
Mailing Address - Fax:
Practice Address - Street 1:3101 COURTNEY LN STE B
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-8519
Practice Address - Country:US
Practice Address - Phone:254-300-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist