Provider Demographics
NPI:1003195470
Name:LANGFORD, AMBER (MS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8669 EAGLE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8628
Mailing Address - Country:US
Mailing Address - Phone:651-379-0444
Mailing Address - Fax:651-379-0448
Practice Address - Street 1:1802 WOODDALE DR STE 101
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2927
Practice Address - Country:US
Practice Address - Phone:651-983-7892
Practice Address - Fax:651-212-4884
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2433101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health