MEDICARE: ALYSE LANGE LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1083579767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALYSE LANGE LLC

Provider Business Mailing Address
First Line	:	1001 2ND ST # 1029
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49001-2571
Country	:	US
Telephone Number	:	269-544-9092
Fax Number	:

Provider Business Practice Location Address
First Line	:	29532 SOUTHFIELD RD, SUITE 115
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076
Country	:	US
Telephone Number	:	269-544-9092
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	ALYSE LANGE
Credential	:	LMSW-CLINICAL
Telephone Number	:	269-544-9092

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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