Provider Demographics
NPI:1205813037
Name:LANG, TIMOTHY PATRICK (PSYD,LP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:LANG
Suffix:
Gender:M
Credentials:PSYD,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 1ST DR NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2941
Mailing Address - Country:US
Mailing Address - Phone:507-434-1092
Mailing Address - Fax:507-434-1477
Practice Address - Street 1:1000 1ST DR NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-2941
Practice Address - Country:US
Practice Address - Phone:507-434-1092
Practice Address - Fax:507-434-1477
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4165103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical