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NPI Code Detail

MEDICARE: JERRY LANGHOLZ LPC

MEDICARE: JERRY LANGHOLZ LPC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorOR
2101YM0800XMental Health CounselorOR
3101YM0800XMental Health CounselorC4973OR

General Provider Information

NPI Number : 1548669633
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY LANGHOLZ LPC
Provider Business Mailing Address
First Line : 61690 PETTIGREW RD
Second Line :
City : BEND
State : OR
Zip : 97702-2422
Country : US
Telephone Number : 541-617-0377
Fax Number :
Provider Business Practice Location Address
First Line : 61690 PETTIGREW RD
Second Line :
City : BEND
State : OR
Zip : 97702-2422
Country : US
Telephone Number : 541-617-0377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2014
Last Update Date : 03/13/2025

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