Individual
MS. LISA LANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, ATRL-BC
Contact information
Practice address
14135 NORTH CEDARBURG ROAD, MEQUON, WI 53097
(414) 702-2324
Mailing address
2027 N 71ST ST, WAUWATOSA, WI 53213-1823
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 #
—
01
—
1952808701
NPI #2/ORGANIZATION NPI #
—
05
—
40961100
—
WI
01
—
51-036
PSYCHOTHERAPY LICENSE #
WI
Enumeration date
11/02/2006
Last updated
06/16/2018
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