| Doctor Name: | AMANDA LANG |
| NPI Number: | 1174870638 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC-IT |
| License Number: | 888-226 |
| Business Practice Address: | 3900 W Brown Deer Rd Ste 200 Brown Deer, WI - 532091220 |
| Business Phone Number: | 4145402170 |
| Business Fax Number: | |
| Mailing Address: | 3900 W Brown Deer Rd Ste 200, BROWN DEER |
| State: | WI |
| Postal Code: | 532091220 |
| Phone Number: | 4145402170 |
| Fax Number: | |
| NPI Enumeration Date: | 08/14/2012 |
| NPI Last Update Date: | 08/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 888-226 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |