Provider Demographics
NPI:1891161634
Name:LANGLEY, GINA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:R
Last Name:LANGLEY
Suffix:
Gender:F
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:PO BOX 2201
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO DOWNS
Mailing Address - State:NM
Mailing Address - Zip Code:88346-2201
Mailing Address - Country:US
Mailing Address - Phone:575-914-0670
Mailing Address - Fax:575-257-2141
Practice Address - Street 1:27061 US HWY 70
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:NM
Practice Address - Zip Code:88324
Practice Address - Country:US
Practice Address - Phone:575-914-0670
Practice Address - Fax:575-257-2141
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM229941103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM229941Medicaid