Individual
TREVOR LANGSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9531 VALPARAISO CT, INDIANAPOLIS, IN 46268-1130
(317) 879-8940
Mailing address
4141 SHORE DR, INDIANAPOLIS, IN 46254-2607
(317) 329-2525
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20043265A
STATE LICENSE
IN
Enumeration date
07/11/2019
Last updated
07/11/2019
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