MEDICARE: MR. KENNETH ALAN LANGIE B.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1023143658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH ALAN LANGIE B.A.

Provider Business Mailing Address
First Line	:	25641 PINE CREEK LN
Second Line	:
City	:	WILMINGTON
State	:	CA
Zip	:	90744-1830
Country	:	US
Telephone Number	:	424-364-7873
Fax Number	:

Provider Business Practice Location Address
First Line	:	5849 CROCKER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1311
Country	:	US
Telephone Number	:	323-234-4445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	03/17/2018

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