Provider Demographics
NPI:1972901890
Name:LANGE, KATHRYN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8790 MANCHESTER RD STE 205E
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2731
Mailing Address - Country:US
Mailing Address - Phone:314-281-7803
Mailing Address - Fax:
Practice Address - Street 1:8790 MANCHESTER RD STE 205E
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2731
Practice Address - Country:US
Practice Address - Phone:314-281-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170103751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical