Provider Demographics
NPI:1851441489
Name:LANG, RANDALL C (PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:C
Last Name:LANG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MARIE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-9006
Mailing Address - Country:US
Mailing Address - Phone:970-626-3432
Mailing Address - Fax:970-626-3432
Practice Address - Street 1:409 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3720
Practice Address - Country:US
Practice Address - Phone:970-626-3432
Practice Address - Fax:970-626-3432
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1336103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO035347Medicaid
COE0516Medicare PIN
CO035347Medicaid