Provider Demographics
NPI:1780136671
Name:ELLIOTT, LANG (BS, MBA)
Entity type:Individual
Prefix:
First Name:LANG
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:BS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210511
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76095-7511
Mailing Address - Country:US
Mailing Address - Phone:682-777-5299
Mailing Address - Fax:
Practice Address - Street 1:221 BEDFORD RD STE 300
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6251
Practice Address - Country:US
Practice Address - Phone:682-777-5299
Practice Address - Fax:855-282-5709
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health