Provider Demographics
NPI:1699331579
Name:LANE, ALEXIS KRISTINA (MSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KRISTINA
Last Name:LANE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8365 BELLA FAMIGLIA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8250
Mailing Address - Country:US
Mailing Address - Phone:702-659-2373
Mailing Address - Fax:
Practice Address - Street 1:6402 MCLEOD DR STE 5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4406
Practice Address - Country:US
Practice Address - Phone:702-898-5311
Practice Address - Fax:702-222-3275
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker