Mary Jane Lane Lmft LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Kirkwood, MO. Organization (NPI-2).
NPI number1770147548
StatusActive
Last updated in NPPESJun 11, 2019
Details
- NPI
- 1770147548
- Entity type
- Organization (NPI-2)
- Legal business name
- Mary Jane Lane Lmft LLC
- Organization subpart
- No
- Enumeration date
- Apr 27, 2019
- Last updated
- Jun 11, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Other names
- Mary Jane Lane Lmft LLC (Doing Business As)
Practice location
412 S Clay Ave # 212Kirkwood, MO 63122-5860
Phone 314-805-2977 · Fax 314-822-9696
Mailing address
412 S Clay Ave # 212Kirkwood, MO 63122-5860
Phone 314-805-2977 · Fax 314-822-9696
Authorized official
Mary Jane Lane
Provider
3148052947
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