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General NPI Number Information
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NPI Number | 1154463297
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Entity Type | Individual
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Provider Name | SHIRLEY JO LANGE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 7100 N HIGH ST STE 304
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City | WORTHINGTON
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State | OH
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Zip | 43085-2316
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Country | US
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Telephone | 614-725-1957
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Fax | 614-846-1059
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Provider Business Mailing Address
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Address Line | 7100 N HIGH ST STE 304
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City | WORTHINGTON
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State | OH
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Zip | 43085-2316
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Country | US
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Telephone | 614-725-1957
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Fax | 614-846-1059
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4293
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 4293
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4293
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License Number State | OH
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