Provider Demographics
NPI:1679583900
Name:LANGSTON, DONNA JEAN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JEAN
Last Name:LANGSTON
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 1:252 UPPER LUTHER RD
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-9555
Mailing Address - Country:US
Mailing Address - Phone:406-446-1683
Mailing Address - Fax:
Practice Address - Street 1:252 UPPER LUTHER RD
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-9555
Practice Address - Country:US
Practice Address - Phone:406-446-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0250767Medicaid
MT740043OtherBLUE CROSS/BLUE SHIELD
MT740283OtherBLUE CROSS/BLUE SHIELD