Provider Demographics
NPI:1639824188
Name:LANGELLO, TRENT COLE
Entity Type:Individual
Prefix:MR
First Name:TRENT
Middle Name:COLE
Last Name:LANGELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 ADAMS AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2779
Mailing Address - Country:US
Mailing Address - Phone:541-962-8800
Mailing Address - Fax:
Practice Address - Street 1:2301 COVE AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-3906
Practice Address - Country:US
Practice Address - Phone:541-962-8800
Practice Address - Fax:541-963-5272
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
ORT-221914101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist