Provider Demographics
NPI:1689006413
Name:LANG, SECRET NICOLE
Entity Type:Individual
Prefix:
First Name:SECRET
Middle Name:NICOLE
Last Name:LANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 E BLACKJACK RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-7245
Mailing Address - Country:US
Mailing Address - Phone:580-239-2978
Mailing Address - Fax:
Practice Address - Street 1:740 E BLACKJACK RD
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-7245
Practice Address - Country:US
Practice Address - Phone:580-239-2978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst