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General NPI Number Information
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NPI Number | 1942319108
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Entity Type | Organization
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Legal Business Name | KEITH D. LANG M.A. LPC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1117 GALLAGHER DR SUITE 470
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City | SHERMAN
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State | TX
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Zip | 75090-1797
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Country | US
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Telephone | 903-821-5518
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Fax |
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Provider Business Mailing Address
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Address Line | 1219 W TEXAS ST
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City | DENISON
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State | TX
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Zip | 75020-5919
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Country | US
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Telephone | 903-821-5518
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | KEITH DEWAYNE LANG
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Credential | M.A.
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Telephone | 903-821-5518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | LPC# 20123
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License Number State | TX
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