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General NPI Number Information
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NPI Number | 1679081459
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Entity Type | Individual
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Provider Name | LANCE J LANGSTON RBT
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Gender | Male
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 2 CROSSTIE CT
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City | PALM COAST
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State | FL
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Zip | 32137
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Country | US
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Telephone | 386-302-7814
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Fax |
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Provider Business Mailing Address
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Address Line | 2 CROSSTIE CT
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City | PALM COAST
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State | FL
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Zip | 32137-1507
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Country | US
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Telephone | 386-302-7814
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-18-7887-89669
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License Number State | FL
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