Healthcare Provider Details

I. General information

NPI: 1891161634
Provider Name (Legal Business Name): GINA R LANGLEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27061 US HWY 70
GLENCOE NM
88324
US

IV. Provider business mailing address

PO BOX 2201
RUIDOSO DOWNS NM
88346-2201
US

V. Phone/Fax

Practice location:
  • Phone: 575-914-0670
  • Fax: 575-257-2141
Mailing address:
  • Phone: 575-914-0670
  • Fax: 575-257-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number229941
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: