Provider Demographics
NPI:1679923353
Name:LANE, MICHAEL (CPRP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LANE
Suffix:
Gender:M
Credentials:CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9719 LINCOLN VILLAGE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3303
Mailing Address - Country:US
Mailing Address - Phone:916-485-4175
Mailing Address - Fax:916-485-2673
Practice Address - Street 1:9719 LINCOLN VILLAGE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3303
Practice Address - Country:US
Practice Address - Phone:916-485-4175
Practice Address - Fax:916-485-2673
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health