Provider Demographics
NPI:1164873576
Name:LANG, WADE (LPCC)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:LANG
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 WATER ST SW
Mailing Address - Street 2:
Mailing Address - City:SLEEPY EYE
Mailing Address - State:MN
Mailing Address - Zip Code:56085-1230
Mailing Address - Country:US
Mailing Address - Phone:507-227-6806
Mailing Address - Fax:
Practice Address - Street 1:1215 S. BRAODWAY
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56085
Practice Address - Country:US
Practice Address - Phone:507-201-4505
Practice Address - Fax:651-323-2053
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01242101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor