| Provider / Organization | NPI | Date Certified |
|---|---|---|
| EVERETT LANE | 1407444938 | 2021-01-10 |
Everett Lane is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1407444938. Registration indicates Everett Lane is a provider of services with a specialization in Behavioral Health & Social Service Providers, Behavior Technician (Behavior Technician, Behavioral Health & Social Service Providers) (Behavior Technician, )
| Entity Type | Individual |
| Provider Name | Mr. Everett Lane RBT |
| Practice Office Address | 4624 PARK ST JACKSONVILLE, FL US |
| Practice Office Telephone | 9045030131 |
| Mailing Address | 7603 ALTAMA RD JACKSONVILLE, FL 322169309 US |
| Business Telephone | 9044771245 |
| Code | Practice | License No State |
|---|---|---|
| 106S00000X PRIMARY | Behavioral Health & Social Service Providers Behavior Technician Behavior Technician Behavioral Health & Social Service Providers Behavior Technician |