Provider Demographics
NPI:1376220202
Name:LANGLEY, TIA JEAN
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:JEAN
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 BLACKTHORN CV
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-3551
Mailing Address - Country:US
Mailing Address - Phone:989-388-1354
Mailing Address - Fax:
Practice Address - Street 1:1016 BLACKTHORN CV
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-3551
Practice Address - Country:US
Practice Address - Phone:989-388-1354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst