Provider Demographics
NPI:1881038214
Name:LANGE, LINDY (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:LINDY
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 CHADWICK LN
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6816
Mailing Address - Country:US
Mailing Address - Phone:815-409-6468
Mailing Address - Fax:
Practice Address - Street 1:4318 W CRYSTAL LAKE RD STE L
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4250
Practice Address - Country:US
Practice Address - Phone:815-331-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011491101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional