Provider Demographics
NPI:1598941916
Name:LANGE, JEFF A (LIMHP)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:A
Last Name:LANGE
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 PARKLANE DR STE 5
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8629
Mailing Address - Country:US
Mailing Address - Phone:308-251-2222
Mailing Address - Fax:888-843-4489
Practice Address - Street 1:5308 PARKLANE DR STE 5
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8629
Practice Address - Country:US
Practice Address - Phone:308-251-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP8301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080829226Medicaid