Provider Demographics
NPI:1750836136
Name:KEISHA J. LANGOLF, LCSW, LLC
Entity Type:Organization
Organization Name:KEISHA J. LANGOLF, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGOLF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-817-0927
Mailing Address - Street 1:3310 E 10TH ST # 365
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-7285
Mailing Address - Country:US
Mailing Address - Phone:812-496-4310
Mailing Address - Fax:502-805-0690
Practice Address - Street 1:2700 VISSING PARK RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5989
Practice Address - Country:US
Practice Address - Phone:812-496-4310
Practice Address - Fax:502-805-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007247A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty