Provider Demographics
NPI:1386303204
Name:LANGLEY, JORDAN ANGELA (LLMSW)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ANGELA
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7369 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:GRAWN
Mailing Address - State:MI
Mailing Address - Zip Code:49637-9664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3335 W SOUTH AIRPORT RD
Practice Address - Street 2:5A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:906-263-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511206801041C0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician