Provider Demographics
NPI:1386221885
Name:LANGTON, KEVIN JAMES (LADC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:LANGTON
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32298 STATE HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:MN
Mailing Address - Zip Code:56069-4348
Mailing Address - Country:US
Mailing Address - Phone:507-364-5312
Mailing Address - Fax:507-364-5908
Practice Address - Street 1:922 SWIFT ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-1844
Practice Address - Country:US
Practice Address - Phone:507-364-5312
Practice Address - Fax:507-364-5908
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305412101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)