Basic Information
| Provider Information | |||||||||
| NPI: | 1194195032 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANGLEY | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | MATTHEW | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMT, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6415 BILLYMACK RD | ||||||||
| Address2: | |||||||||
| City: | ELIDA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458079748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193024690 | ||||||||
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| Practice Location | |||||||||
| Address1: | 797 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458041519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192292222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2015 | ||||||||
| LastUpdateDate: | 05/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 022335 | OH | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 104100000X | S.2004844 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.