Provider Demographics
NPI:1861830218
Name:WESTON LANGE
Entity Type:Organization
Organization Name:WESTON LANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:WESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:209-678-8680
Mailing Address - Street 1:125 N BROADWAY
Mailing Address - Street 2:SUTIE 2F
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-4811
Mailing Address - Country:US
Mailing Address - Phone:209-678-8680
Mailing Address - Fax:209-667-8680
Practice Address - Street 1:125 N BROADWAY
Practice Address - Street 2:SUTIE 2F
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4811
Practice Address - Country:US
Practice Address - Phone:209-678-8680
Practice Address - Fax:209-667-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA215221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty