Provider Demographics
NPI:1356800759
Name:LANGLEY, DANIELLE DOMINIQUE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DOMINIQUE
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 SILVER LEAF EXT
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-9667
Mailing Address - Country:US
Mailing Address - Phone:509-760-7943
Mailing Address - Fax:
Practice Address - Street 1:1286 E SALES YARD RD
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-9083
Practice Address - Country:US
Practice Address - Phone:208-329-8421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60937927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health