Provider Demographics
NPI:1851642706
Name:MEL LANGSTON PROFESSIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:MEL LANGSTON PROFESSIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, CADC III
Authorized Official - Phone:503-791-3181
Mailing Address - Street 1:5 N HIGHWAY 101
Mailing Address - Street 2:#349
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9313
Mailing Address - Country:US
Mailing Address - Phone:503-791-3181
Mailing Address - Fax:
Practice Address - Street 1:2245 N WAHANNA RD
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-7833
Practice Address - Country:US
Practice Address - Phone:503-791-3181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1701251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health