Provider Demographics
NPI:1588537864
Name:LANE, TYRONE ALPHONSO
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:ALPHONSO
Last Name:LANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TY
Other - Middle Name:ALPHONSO
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2510 E SUNSET RD STE B208
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3511
Mailing Address - Country:US
Mailing Address - Phone:702-685-0877
Mailing Address - Fax:702-749-5922
Practice Address - Street 1:5472 BULLS BAY DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7199
Practice Address - Country:US
Practice Address - Phone:702-685-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060168371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical