Provider Demographics
NPI:1558174920
Name:LANG, JAJA (MA, LEP)
Entity type:Individual
Prefix:
First Name:JAJA
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:MA, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 CAYO GRANDE CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1945
Mailing Address - Country:US
Mailing Address - Phone:805-263-7081
Mailing Address - Fax:
Practice Address - Street 1:865 CAYO GRANDE CT
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-1945
Practice Address - Country:US
Practice Address - Phone:805-263-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP4574103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool