Healthcare Provider Details

I. General information

NPI: 1003694829
Provider Name (Legal Business Name): BENJAMIN LANGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 WOODLAND PARK AVE N UNIT 208
SEATTLE WA
98103-7499
US

IV. Provider business mailing address

4444 WOODLAND PARK AVE N UNIT 208
SEATTLE WA
98103-7499
US

V. Phone/Fax

Practice location:
  • Phone: 251-533-4608
  • Fax:
Mailing address:
  • Phone: 251-533-4608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC.61568912
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: