Healthcare Provider Details

I. General information

NPI: 1275017469
Provider Name (Legal Business Name): JAMIE RYAN LANG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 S COMMERCE ST BLDG C
ARDMORE OK
73401-5519
US

IV. Provider business mailing address

PO BOX 189
ARDMORE OK
73402-0189
US

V. Phone/Fax

Practice location:
  • Phone: 580-226-5048
  • Fax: 580-226-3569
Mailing address:
  • Phone: 580-319-7305
  • Fax: 580-319-7328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: