Healthcare Provider Details

I. General information

NPI: 1265910400
Provider Name (Legal Business Name): KARA LANGE LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 N BROAD ST
ADRIAN MI
49221-2762
US

IV. Provider business mailing address

3425 FRANCIS ST
JACKSON MI
49203-5052
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-2191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNLC.0107833
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: