Basic Information
| Provider Information | |||||||||
| NPI: | 1710553573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 844658 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752844658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547242111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7700 FISH POND RD | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767101031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547614444 | ||||||||
| FaxNumber: | 2547614441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2021 | ||||||||
| LastUpdateDate: | 03/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TA0400X | 38710 | TX | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TH0004X | 38710 | TX | N | Behavioral Health & Social Service Providers | Psychologist | Health | 103TB0200X | 38710 | TX | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | 38710 | TX | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.