Provider Demographics
NPI:1982923678
Name:LANGLEY, KEVIN LYNN (BS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LYNN
Last Name:LANGLEY
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 E HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-1906
Mailing Address - Country:US
Mailing Address - Phone:580-225-4337
Mailing Address - Fax:580-225-4338
Practice Address - Street 1:1021 E HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-1906
Practice Address - Country:US
Practice Address - Phone:580-225-4337
Practice Address - Fax:580-225-4338
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor