Provider Demographics
NPI:1679617054
Name:LANGE, DAVID ERNST (MA, LCPC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ERNST
Last Name:LANGE
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:MR
Other - First Name:DAVE
Other - Middle Name:
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LCPC
Mailing Address - Street 1:1335 JELLISON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-9039
Mailing Address - Country:US
Mailing Address - Phone:406-892-3073
Mailing Address - Fax:
Practice Address - Street 1:30 E WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3968
Practice Address - Country:US
Practice Address - Phone:406-212-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1294-LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional