Healthcare Provider Details

I. General information

NPI: 1164144861
Provider Name (Legal Business Name): ANNE V LANGE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 N MEMORIAL DR
LANCASTER OH
43130-2563
US

IV. Provider business mailing address

721 N MEMORIAL DR
LANCASTER OH
43130-2563
US

V. Phone/Fax

Practice location:
  • Phone: 740-202-7110
  • Fax:
Mailing address:
  • Phone: 740-202-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2204506
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2204506
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: