Provider Demographics
NPI:1538786017
Name:KANE, JANEL HOPE (LAC)
Entity type:Individual
Prefix:MS
First Name:JANEL
Middle Name:HOPE
Last Name:KANE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:JANEL
Other - Middle Name:HOPE
Other - Last Name:SHEPPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1405 E BROADWAY STREET
Mailing Address - Street 2:APT, A201
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802
Mailing Address - Country:US
Mailing Address - Phone:406-214-5616
Mailing Address - Fax:406-926-1454
Practice Address - Street 1:202 BROOKS ST STE 300
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4019
Practice Address - Country:US
Practice Address - Phone:406-926-1453
Practice Address - Fax:406-926-1454
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-43741101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT810541853Medicaid