Organization
KELLY M. LANGE, M.A, L.L.P
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MARIE LANGE M.A., L.L.P. (CLINICIAN)
(734) 754-1172
Entity
Organization
Contact information
Practice address
496 W ANN ARBOR TRL STE 106, PLYMOUTH, MI 48170-6262
(734) 754-1172
Mailing address
41422 STRAWBERRY CT, CANTON, MI 48188-5244
(734) 754-1172
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
10/03/2019
Last updated
10/03/2019
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