MEDICARE: MICHELLE LANG

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1386029817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LANG

Provider Business Mailing Address
First Line	:	3465 W. CRAIG ROAD
Second Line	:	SUITE D
City	:	LAS VEGAS
State	:	NV
Zip	:	89032
Country	:	US
Telephone Number	:	888-505-1376
Fax Number	:	888-501-0472

Provider Business Practice Location Address
First Line	:	3465 W CRAIG RD
Second Line	:	SUITE D
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5120
Country	:	US
Telephone Number	:	888-505-1376
Fax Number	:	888-501-0472

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

Provider Enumeration Date	:	07/27/2015
Last Update Date	:	07/27/2015

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Directions to “ MICHELLE LANG ” Practice Location

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