Provider Demographics
NPI:1316165137
Name:LANGE, KATHI JEAN (LMFT, LCSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:KATHI
Middle Name:JEAN
Last Name:LANGE
Suffix:
Gender:F
Credentials:LMFT, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:303 SOUTH PERRY STREET
Mailing Address - City:ATTICA
Mailing Address - State:IN
Mailing Address - Zip Code:47918-0340
Mailing Address - Country:US
Mailing Address - Phone:765-762-0611
Mailing Address - Fax:765-762-1753
Practice Address - Street 1:303 S PERRY ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:IN
Practice Address - Zip Code:47918-1441
Practice Address - Country:US
Practice Address - Phone:765-762-0611
Practice Address - Fax:765-762-1753
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000883A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical