MEDICARE: ANNA LANG COUNSELOR

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP 00006240	WA

General Provider Information

NPI Number	:	1346649092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA LANG COUNSELOR

Provider Business Mailing Address
First Line	:	211 PIONEER RD W
Second Line	:
City	:	LONG BEACH
State	:	WA
Zip	:	98631-3654
Country	:	US
Telephone Number	:	360-642-2697
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 PIONEER RD W
Second Line	:
City	:	LONG BEACH
State	:	WA
Zip	:	98631-3654
Country	:	US
Telephone Number	:	360-642-2697
Fax Number	:

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

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	08/19/2014

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