Provider Demographics
NPI:1124147079
Name:LANGE, GARY C (PHD LMFT LCPC MS LPC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:C
Last Name:LANGE
Suffix:
Gender:M
Credentials:PHD LMFT LCPC MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 RIDGEGATE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3557
Mailing Address - Country:US
Mailing Address - Phone:972-530-0871
Mailing Address - Fax:972-530-0871
Practice Address - Street 1:2862 N BELTLINE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9388
Practice Address - Country:US
Practice Address - Phone:972-698-8478
Practice Address - Fax:972-698-8469
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL75029101YP1600X
TX3682101YP2500X
TX759106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist