MEDICARE: MR. DAVID ERNST LANGE M.A., LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1294-LCPC	MT

General Provider Information

NPI Number	:	1679617054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ERNST LANGE M.A., LCPC

Provider Business Mailing Address
First Line	:	1335 JELLISON RD
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-9039
Country	:	US
Telephone Number	:	406-892-3073
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 E WASHINGTON ST
Second Line	:	SUITE A
City	:	KALISPELL
State	:	MT
Zip	:	59901-3968
Country	:	US
Telephone Number	:	406-212-8206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2007
Last Update Date	:	07/08/2007

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