=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336838614
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNIFER LANG COUNSELING PLCC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2023
-----------------------------------------------------
Last Update Date | 05/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5208 NEW MEXICO ST
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98661-6621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-397-7322
-----------------------------------------------------
Fax | 360-397-7322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5208 NEW MEXICO ST
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98661-6621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-775-5833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JENNIFER L LANG
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 503-775-5833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------