Provider Demographics
NPI:1336436757
Name:SUSAN ARNOLD LANGE, PSYCHOLOGIST, LPPC
Entity type:Organization
Organization Name:SUSAN ARNOLD LANGE, PSYCHOLOGIST, LPPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:PH, D
Authorized Official - Phone:817-745-4612
Mailing Address - Street 1:9500 RAY WHITE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-9104
Mailing Address - Country:US
Mailing Address - Phone:817-745-4612
Mailing Address - Fax:817-745-4611
Practice Address - Street 1:9500 RAY WHITE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9104
Practice Address - Country:US
Practice Address - Phone:817-745-4612
Practice Address - Fax:817-745-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3082103TP2701X, 106H00000X, 101Y00000X, 101YM0800X, 101YP2500X, 103TB0200X, 103TH0004X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty