MEDICARE: JENNIFER E. LANG LMFT

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	106H00000X	Marriage & Family Therapist	35001483A	IN

General Provider Information

NPI Number	:	1700287158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER E. LANG LMFT

Provider Business Mailing Address
First Line	:	610 N LEBANON ST
Second Line	:
City	:	LEBANON
State	:	IN
Zip	:	46052-1716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 W OAK ST STE 200
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-3836
Country	:	US
Telephone Number	:	765-680-0071
Fax Number	:	765-680-0468

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

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	09/15/2020

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