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General NPI Number Information
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NPI Number | 1740916154
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Entity Type | Individual
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Provider Name | MICHELLE LANGE LCPC
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Gender | Female
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 2445 FIRE MESA ST
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City | LAS VEGAS
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State | NV
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Zip | 89128-9014
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Country | US
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Telephone | 702-456-4262
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Fax |
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Provider Business Mailing Address
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Address Line | 7816 PICNIC ST
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City | LAS VEGAS
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State | NV
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Zip | 89131-8264
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Country | US
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Telephone | 702-882-6253
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CP5845
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License Number State | NV
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