Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | 75029 | FL |
N | 101YP2500X | Professional Counselor | 3682 | TX |
NPI | 1124147079 |
---|---|
Provider Name | Mr. Gary C Lange |
First Address | Garland, TX 75040-3557 |
Second Address | Sunnyvale, TX 75182-9388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 08/07/2007 |