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General NPI Number Information
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NPI Number | 1063967255
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Entity Type | Organization
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Legal Business Name | KIRSTEN S. LANGLEY, PSY.D. P.C.
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE #1318
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City | CHICAGO
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State | IL
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Zip | 60602-3402
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Country | US
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Telephone | 312-718-3336
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 W ADAMS ST UNIT 909
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City | CHICAGO
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State | IL
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Zip | 60607-2867
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Country | US
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Telephone | 773-480-1866
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ CLINICAL PSYCHOLOGIST
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Name | DR. KIRSTEN SENICA LANGLEY
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Credential | PSY.D.
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Telephone | 773-480-1866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007807
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License Number State | IL
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