Lane, William Bradford
Lane, William Bradford is an sole proprietor health care provider with primary practice located at 409 Washington Ave , Pocatello ID 83201-4520. He recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as his primary health care specialty. Lane, William Bradford can be contacted via phone (208) 234-2646.Contact Information
Primary practice address
409 Washington Ave
Pocatello ID 83201-4520
Phone: (208) 234-2646
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Counselor | 101Y00000X | LPC-6550 | Idaho |
Profile Details
| NPI number | 1124542147 |
|---|---|
| LBN Legal business name | Lane, William Bradford |
| Credentials | Licensed Professional Counselor (LPC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 1st, 2017 |
| Last updated | Jul 21st, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124542147 | NPPES |
| Idaho | MEDICAID | 1619177797 |
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