Basic Information
Provider Information
NPI: 1598838542
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LANG
FirstName: DONALD
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PHD, LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3801 BLUE PKWY
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641302807
CountryCode: US
TelephoneNumber: 8169235800
FaxNumber:  
Practice Location
Address1: 3801 BLUE PKWY
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641302807
CountryCode: US
TelephoneNumber: 8169235800
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/16/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X#002738MOY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home