Provider Demographics
NPI:1427448612
Name:LANGE-BRANDT, JOELLEN (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JOELLEN
Middle Name:
Last Name:LANGE-BRANDT
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10905 LANSING AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-9456
Mailing Address - Country:US
Mailing Address - Phone:612-709-8150
Mailing Address - Fax:
Practice Address - Street 1:10905 LANSING AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-9456
Practice Address - Country:US
Practice Address - Phone:612-709-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3182106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist