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General NPI Number Information
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NPI Number | 1952808701
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Entity Type | Organization
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Legal Business Name | LISA LANG LLC
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 14135 NORTH CEDARBURG ROAD
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City | MEQUON
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State | WI
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Zip | 53097
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Country | US
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Telephone | 414-702-2324
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Fax |
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Provider Business Mailing Address
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Address Line | 2027 NORTH 71ST STREET
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City | WAUWATOSA
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State | WI
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Zip | 53213
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Country | US
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Telephone | 414-702-2119
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOTHERAPIST
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Name | MS. LISA LANG
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Credential | MS, ATRL-BC
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Telephone | 414-702-2119
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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 | 51-036
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 51-036
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License Number State | WI
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