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Organization
LISA LANG LLC
Active
Organization
LISA LANG LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA LANG MS, ATRL-BC (LICENSED PSYCHOTHERAPIST)
(414) 702-2119
Entity
Organization
Contact information
Practice address
14135 NORTH CEDARBURG ROAD, MEQUON, WI 53097
(414) 702-2324
Mailing address
2027 NORTH 71ST STREET, WAUWATOSA, WI 53213
(414) 702-2119
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
51-036
WI
221700000X
Art Therapist
Primary
51-036
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-226
ATCB BOARD CERTIFICATION #
—
01
—
1902985922
INDIVIDUAL NPI #
—
05
—
40961100
—
WI
01
—
51-036
PSYCHOTHERAPY LICENSE #
WI
Enumeration date
04/09/2018
Last updated
04/09/2018
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