Provider Demographics
NPI:1487867065
Name:LANG, CHRISTINE (MFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DOYLE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2129
Mailing Address - Country:US
Mailing Address - Phone:831-234-1411
Mailing Address - Fax:831-426-1189
Practice Address - Street 1:100 DOYLE ST
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2129
Practice Address - Country:US
Practice Address - Phone:831-234-1411
Practice Address - Fax:831-426-1189
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53769106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA53769OtherPSYCHOTHERAPY