| Lisa Lang Llc | |
|
14135 North Cedarburg Road Mequon WI 53097 | |
| (414) 702-2324 | |
| Not Available |
| Full Name | Lisa Lang Llc |
|---|---|
| Speciality | Art Therapist |
| Location | 14135 North Cedarburg Road, Mequon, Wisconsin |
| Authorized Official Name and Position | Lisa Lang (LICENSED PSYCHOTHERAPIST) |
| Authorized Official Contact | 4147022119 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Lang Llc 2027 North 71st Street Wauwatosa WI 53213 Ph: (414) 702-2119 | Lisa Lang Llc 14135 North Cedarburg Road Mequon WI 53097 Ph: (414) 702-2324 |
| NPI Number | 1952808701 |
|---|---|
| Provider Enumeration Date | 04/09/2018 |
| Last Update Date | 04/09/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952808701 | NPI | - | NPPES |
| 51-036 | Other | WI | PSYCHOTHERAPY LICENSE # |
| 01-226 | Other | ATCB BOARD CERTIFICATION # | |
| 1902985922 | Other | INDIVIDUAL NPI # | |
| 40961100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 51-036 (Wisconsin) | Secondary |
| 221700000X | Art Therapist | 51-036 (Wisconsin) | Primary |
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