Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 2433 | MN |
NPI | 1003195470 |
---|---|
Provider Name | Amber Langford |
First Address | Lake Elmo, MN 55042-8628 |
Second Address | Lake Elmo, MN 55042-8628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2011 |
Last Update Date | 23/12/2011 |