Provider Demographics
NPI:1619475803
Name:HENRY-LANGE, SHAWNA (LPC)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:HENRY-LANGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7390 DOVER ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-4258
Mailing Address - Country:US
Mailing Address - Phone:720-231-3702
Mailing Address - Fax:
Practice Address - Street 1:7390 DOVER ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-4258
Practice Address - Country:US
Practice Address - Phone:720-231-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health