Healthcare Provider Details

I. General information

NPI: 1285547745
Provider Name (Legal Business Name): JAMES VINCENT LANGE LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 BUSINESS 371
BRAINERD MN
56401-8306
US

IV. Provider business mailing address

2424 BUSINESS 371, BRAINERD, MN 56401
BRAINERD MN
56401
US

V. Phone/Fax

Practice location:
  • Phone: 218-833-8758
  • Fax:
Mailing address:
  • Phone: 218-833-8758
  • Fax: 218-833-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number302081
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: