Healthcare Provider Details

I. General information

NPI: 1942047311
Provider Name (Legal Business Name): CAMRYN LANGLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 FORDEM AVE
MADISON WI
53704-4604
US

IV. Provider business mailing address

1724 WILLOW ROCK RD APT 201
MADISON WI
53718-9266
US

V. Phone/Fax

Practice location:
  • Phone: 608-221-3511
  • Fax: 608-221-3514
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12409-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12196
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: