=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467508986
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM LANGFORD III M.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 05/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5979 VINELAND RD SUITE 210
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-7800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-351-1010
-----------------------------------------------------
Fax | 407-351-5170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8654 VISTA PINE CT
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32836-6307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-351-1010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT0959
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------