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Kirt Lane, CPC
Peer Specialist in Longview, Washington
NPI 1013541341

Kirt Lane is a Peer Specialist based in Longview, WA. Kirt Lane practices in Longview, WA and has the professional credentials of CPC. The NPI Number for Kirt Lane is 1013541341 and holds a License No. (Washington).

The current practice location address for Kirt Lane is 1408 12Th Avenue, Longview, WA and can be reached out via phone at 360-998-3050 and via fax at 360-200-6736.

Location: 1408 12Th Avenue, Longview, WA, 98632
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1013541341
Provider Name
Kirt Lane
Credential
CPC
Provider Entity Type
Individual
Gender
Male
Address
1408 12Th Avenue, Longview, WA, 98632
Phone Number
360-998-3050
Fax Number
360-200-6736
Provider Enumeration Date
02/25/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
2154878 05 WA
institution
Provider Business Practice Location Address Details
Address
1408 12Th Avenue
City
Longview
State
Washington
Zip
98632-3822
Phone Number
360-998-3050
Fax Number
360-200-6736
person
Provider Business Mailing Address Details
Address
1408 12Th Avenue
City
Longview
State
Washington
Zip
98632-3822
Phone Number
360-998-3050
Fax Number
360-200-6736
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
()
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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