Provider Demographics
NPI:1215180633
Name:LANGE, MATTHEW DEAN (LPC-MH)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DEAN
Last Name:LANGE
Suffix:
Gender:M
Credentials:LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E CENTRE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-3002
Mailing Address - Country:US
Mailing Address - Phone:605-787-4205
Mailing Address - Fax:605-348-2099
Practice Address - Street 1:1501 E CENTRE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-3002
Practice Address - Country:US
Practice Address - Phone:605-787-4205
Practice Address - Fax:605-348-2099
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health