Healthcare Provider Details

I. General information

NPI: 1336436757
Provider Name (Legal Business Name): SUSAN ARNOLD LANGE, PSYCHOLOGIST, LPPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 RAY WHITE RD SUITE 200
FORT WORTH TX
76244-9104
US

IV. Provider business mailing address

9500 RAY WHITE RD SUITE 200
FORT WORTH TX
76244-9104
US

V. Phone/Fax

Practice location:
  • Phone: 817-745-4612
  • Fax: 817-745-4611
Mailing address:
  • Phone: 817-745-4612
  • Fax: 817-745-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number2-3082
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2-3082
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2-3082
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2-3082
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2-3082
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number2-3082
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number2-3082
License Number StateTX
# 8
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2-3082
License Number StateTX

VIII. Authorized Official

Name: DR. SUSAN ARNOLD LANGE
Title or Position: PSYCHOLOGIST
Credential: PH,. D.
Phone: 817-745-4612