Provider Demographics
NPI:1437259900
Name:LANGHAM, EDWARD M (LMSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:M
Last Name:LANGHAM
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SANDRA CT
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-1240
Mailing Address - Country:US
Mailing Address - Phone:989-799-1815
Mailing Address - Fax:775-361-1240
Practice Address - Street 1:3521 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3267
Practice Address - Country:US
Practice Address - Phone:989-791-3756
Practice Address - Fax:775-361-1240
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010183761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008971440OtherBLUE CROSS BLUE SHIELD MI
MI8008971440OtherBLUE CROSS BLUE SHIELD MI