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Organization

KELLY L. LANGE PSYCHOLOGY, A PROFESSIONAL CORPORATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KELLY L. LANGE PH.D. (CLINICAL NEUROPSYCHOLOGIST)
(858) 218-4601
Entity
Organization

Contact information

Practice address
9606 TIERRA GRANDE ST, SUITE 107, SAN DIEGO, CA 92126-6501
(858) 693-3113
Mailing address
9606 TIERRA GRANDE ST, SUITE 107, SAN DIEGO, CA 92126-6501
(858) 693-3113

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
21401
CA

Other

Enumeration date
07/07/2007
Last updated
08/22/2020
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