Provider Demographics
NPI:1104194661
Name:LANGE, JULIE CHRISTINE (LADC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CHRISTINE
Last Name:LANGE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:CHIRSTINE
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:1941 S 42ND ST
Mailing Address - Street 2:SUITE 514
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2939
Mailing Address - Country:US
Mailing Address - Phone:402-614-8444
Mailing Address - Fax:402-614-8443
Practice Address - Street 1:1941 S 42ND ST
Practice Address - Street 2:SUITE 514
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2939
Practice Address - Country:US
Practice Address - Phone:402-614-8444
Practice Address - Fax:402-614-8443
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE838101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)