Provider Demographics
NPI:1902616220
Name:LANGELLIER, KRISTEN A
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:LANGELLIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:COFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 N 1ST ST STE 225
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-3760
Mailing Address - Country:US
Mailing Address - Phone:217-788-4065
Mailing Address - Fax:217-788-4147
Practice Address - Street 1:901 N 1ST ST STE 225
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3760
Practice Address - Country:US
Practice Address - Phone:217-788-4065
Practice Address - Fax:217-788-4147
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178020091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health