Provider Demographics
NPI:1932386331
Name:LANGAN, MARSHALL
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:
Last Name:LANGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 S COOPER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5392
Mailing Address - Country:US
Mailing Address - Phone:480-398-1994
Mailing Address - Fax:480-398-1997
Practice Address - Street 1:5960 S COOPER RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5392
Practice Address - Country:US
Practice Address - Phone:480-398-1994
Practice Address - Fax:480-398-1997
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2839372103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool