Provider Demographics
NPI:1912632969
Name:LANE, GAYLE ROBIN (LCPC)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:ROBIN
Last Name:LANE
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N MILL ST STE M
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4866
Mailing Address - Country:US
Mailing Address - Phone:630-536-8073
Mailing Address - Fax:
Practice Address - Street 1:1801 N MILL ST STE M
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4866
Practice Address - Country:US
Practice Address - Phone:630-536-8073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.016719101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional