Provider Demographics
NPI:1811147119
Name:LANG, LISA (LCPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 SHERIDAN RD
Mailing Address - Street 2:216
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2547
Mailing Address - Country:US
Mailing Address - Phone:203-232-6982
Mailing Address - Fax:
Practice Address - Street 1:1866 SHERIDAN RD
Practice Address - Street 2:216
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2547
Practice Address - Country:US
Practice Address - Phone:203-232-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009285101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid