Provider Demographics
NPI:1487789731
Name:LANGE, WESTON GARRETT (LCSW)
Entity type:Individual
Prefix:
First Name:WESTON
Middle Name:GARRETT
Last Name:LANGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N BROADWAY
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-4811
Mailing Address - Country:US
Mailing Address - Phone:209-678-8680
Mailing Address - Fax:209-667-8680
Practice Address - Street 1:125 N BROADWAY
Practice Address - Street 2:SUITE 2F
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4811
Practice Address - Country:US
Practice Address - Phone:209-678-8680
Practice Address - Fax:209-667-8680
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA215221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical