Provider Demographics
NPI:1497827596
Name:KACHEL SLANGA, JAMES CASEY (MA LP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CASEY
Last Name:KACHEL SLANGA
Suffix:
Gender:M
Credentials:MA LP
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:CASEY
Other - Last Name:SLANGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LP
Mailing Address - Street 1:1280 NORTH BIRCH LAKE BLVD
Mailing Address - Street 2:WHITE BEAR LAKE AREA COMMUNITY COUNSELING CENTER
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-6708
Mailing Address - Country:US
Mailing Address - Phone:651-429-8544
Mailing Address - Fax:651-407-5301
Practice Address - Street 1:1280 NORTH BIRCH LAKE BLVD
Practice Address - Street 2:WHITE BEAR LAKE AREA COMMUNITY COUNSELING CENTER
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-6708
Practice Address - Country:US
Practice Address - Phone:651-429-8544
Practice Address - Fax:651-407-5301
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMNLP#LP0885103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN38P56KAOtherBLUE CROSS BLUE SHIELD
MN30137OtherBEHAVIORAL HEALTHCARE PRO