Provider Demographics
NPI:1942580626
Name:LANG, MICHAEL S (MA, LCPC, CSAT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:LANG
Suffix:
Gender:M
Credentials:MA, LCPC, CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 WHITE HALL TER
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1384
Mailing Address - Country:US
Mailing Address - Phone:630-258-7866
Mailing Address - Fax:
Practice Address - Street 1:1 TIFFANY PT STE 210
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108
Practice Address - Country:US
Practice Address - Phone:630-258-7866
Practice Address - Fax:866-855-9474
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional