Provider Demographics
NPI:1891959961
Name:LANG, RAQUEL (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:AGUILERA-HENNESSY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:6621 DONIPHAN DR STE G
Mailing Address - Street 2:
Mailing Address - City:CANUTILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79835-5005
Mailing Address - Country:US
Mailing Address - Phone:915-877-5100
Mailing Address - Fax:915-877-5107
Practice Address - Street 1:6621 DONIPHAN DR STE G
Practice Address - Street 2:
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835-5005
Practice Address - Country:US
Practice Address - Phone:915-877-5100
Practice Address - Fax:915-877-5107
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NM0130611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM64153274Medicaid