Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 12026 | TX |
N | 103TS0200X | School Psychologist | 31818 | TX |
NPI | 1013071737 |
---|---|
Provider Name | Ms. Katrina G Lane |
First Address | Richardson, TX 75080-5604 |
Second Address | Richardson, TX 75080-5604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LP0008996 | (05) | TX |