Healthcare Provider Details

I. General information

NPI: 1194876045
Provider Name (Legal Business Name): JEFFERY LANGE LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 N 1ST ST STE 201
GENEVA IL
60134-2285
US

IV. Provider business mailing address

760 CAROL AVE
ELGIN IL
60123-2618
US

V. Phone/Fax

Practice location:
  • Phone: 866-586-6049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.017813
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: