Healthcare Provider Details

I. General information

NPI: 1134207780
Provider Name (Legal Business Name): JENNIFER H. LANG MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 CRAIG RD. SUITE 304
ST. LOUIS MO
63141
US

IV. Provider business mailing address

745 CRAIG RD. SUITE 304
ST. LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 314-983-9300
  • Fax: 314-983-9308
Mailing address:
  • Phone: 314-983-9300
  • Fax: 314-983-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2002014226
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: