Healthcare Provider Details

I. General information

NPI: 1669839890
Provider Name (Legal Business Name): DAVID CODY LANGE LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35363 SANTA MARIA ST
YUCAIPA CA
92399-5575
US

IV. Provider business mailing address

35363 SANTA MARIA ST
YUCAIPA CA
92399-5575
US

V. Phone/Fax

Practice location:
  • Phone: 951-775-0557
  • Fax:
Mailing address:
  • Phone: 951-775-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT121823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: