Provider Demographics
NPI:1215253075
Name:TOMLIN-LANGE, LEANNA J (MA, LCPC, CADC)
Entity type:Individual
Prefix:MS
First Name:LEANNA
Middle Name:J
Last Name:TOMLIN-LANGE
Suffix:
Gender:F
Credentials:MA, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 SO. SPRING STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704
Mailing Address - Country:US
Mailing Address - Phone:217-528-1988
Mailing Address - Fax:217-528-1989
Practice Address - Street 1:925 S SPRING ST
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-2784
Practice Address - Country:US
Practice Address - Phone:217-528-1988
Practice Address - Fax:217-528-1989
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006377101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional