=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861830218
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTON LANGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2013
-----------------------------------------------------
Last Update Date | 06/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 N BROADWAY SUTIE 2F
-----------------------------------------------------
City | TURLOCK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95380-4811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-678-8680
-----------------------------------------------------
Fax | 209-667-8680
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 N BROADWAY SUTIE 2F
-----------------------------------------------------
City | TURLOCK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95380-4811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-678-8680
-----------------------------------------------------
Fax | 209-667-8680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | WESTON LANGE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 209-678-8680
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 21522
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------