Provider Demographics
NPI:1972927861
Name:TYRONE D. LANE ENTERPRISES, INCORPORATED
Entity type:Organization
Organization Name:TYRONE D. LANE ENTERPRISES, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MPSY
Authorized Official - Phone:678-677-4041
Mailing Address - Street 1:5304 PANOLA INDUSTRIAL BOULEVARD
Mailing Address - Street 2:SUITE L
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035
Mailing Address - Country:US
Mailing Address - Phone:678-677-4041
Mailing Address - Fax:
Practice Address - Street 1:5304 PANOLA INDUSTRIAL BOULEVARD
Practice Address - Street 2:SUITE L
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035
Practice Address - Country:US
Practice Address - Phone:678-677-4041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable