Provider Demographics
NPI:1912420498
Name:LANGE, JAMIE K (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:K
Last Name:LANGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5103 N WILDRYE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3823
Mailing Address - Country:US
Mailing Address - Phone:208-447-7368
Mailing Address - Fax:
Practice Address - Street 1:760 E WARM SPRINGS AVE STE F
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6459
Practice Address - Country:US
Practice Address - Phone:208-447-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6579101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health