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NPI Code Detail

MEDICARE: BRENT ALAN LANG PH.D.

MEDICARE: BRENT ALAN LANG PH.D.
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
1103T00000XPsychologist38710TX

General Provider Information

NPI Number : 1710553573
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENT ALAN LANG PH.D.
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-2111
Fax Number :
Provider Business Practice Location Address
First Line : 7700 FISH POND RD
Second Line :
City : WACO
State : TX
Zip : 76710-1031
Country : US
Telephone Number : 254-761-4444
Fax Number : 254-761-4441
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2021
Last Update Date : 05/29/2026

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