Healthcare Provider Details

I. General information

NPI: 1447754239
Provider Name (Legal Business Name): STEVEN OLAF LANGEHOUGH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 PINE ST
BURLINGTON VT
05401-5353
US

IV. Provider business mailing address

208 FLYNN AVE STE 3J
BURLINGTON VT
05401-5420
US

V. Phone/Fax

Practice location:
  • Phone: 802-488-6600
  • Fax: 802-488-6919
Mailing address:
  • Phone: 802-488-6920
  • Fax: 802-488-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151.0128054
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: