Healthcare Provider Details

I. General information

NPI: 1609966589
Provider Name (Legal Business Name): THOMAS W LANGHAM JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 N WESTMORELAND RD
DALLAS TX
75211-1655
US

IV. Provider business mailing address

3200 WILLIAMS PL
FORT WORTH TX
76111-5322
US

V. Phone/Fax

Practice location:
  • Phone: 214-331-0107
  • Fax:
Mailing address:
  • Phone: 817-222-9348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number522125
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: