Provider Demographics
NPI:1679012702
Name:LANGSTON, MASTOR
Entity Type:Individual
Prefix:
First Name:MASTOR
Middle Name:
Last Name:LANGSTON
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 1:900 DOOLITTLE AVE
Mailing Address - Street 2:APT 216
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2590
Mailing Address - Country:US
Mailing Address - Phone:702-576-5917
Mailing Address - Fax:
Practice Address - Street 1:900 DOOLITTLE AVE
Practice Address - Street 2:APT 216
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2590
Practice Address - Country:US
Practice Address - Phone:702-576-5917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst