Provider Demographics
NPI:1275732919
Name:LANGE, GARY FRANCIS (PHD, MFT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:FRANCIS
Last Name:LANGE
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-750 RANCHO LAS PALMAS DRIVE
Mailing Address - Street 2:SUITE K-4
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-773-1014
Mailing Address - Fax:
Practice Address - Street 1:41-750 RANCHO LAS PALMAS DRIVE
Practice Address - Street 2:SUITE K-4
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-773-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25633106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist