Provider Demographics
NPI:1003113713
Name:LANGE, LYNETTE (MA, LLPC)
Entity Type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14930 LAPLAISANCE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3880
Mailing Address - Country:US
Mailing Address - Phone:734-241-0180
Mailing Address - Fax:
Practice Address - Street 1:14930 LAPLAISANCE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3880
Practice Address - Country:US
Practice Address - Phone:734-241-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional