Healthcare Provider Details

I. General information

NPI: 1942416706
Provider Name (Legal Business Name): BENJAMIN KEIL LANGMAN LPC CAADC CCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W OAK AVE
PANAMA CITY FL
32401-2737
US

IV. Provider business mailing address

421 W OAK AVE
PANAMA CITY FL
32401-2737
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-6007
  • Fax: 850-215-6003
Mailing address:
  • Phone: 850-215-6007
  • Fax: 850-215-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15273-132
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number201261
License Number StateZZ
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC00806
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401009346
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH19364
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number3203052217
License Number StateMI
# 7
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009346
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: