Healthcare Provider Details

I. General information

NPI: 1679583900
Provider Name (Legal Business Name): DONNA JEAN LANGSTON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 UPPER LUTHER RD
RED LODGE MT
59068-9555
US

IV. Provider business mailing address

252 UPPER LUTHER RD
RED LODGE MT
59068-9555
US

V. Phone/Fax

Practice location:
  • Phone: 406-446-1683
  • Fax:
Mailing address:
  • Phone: 406-446-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number848
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: