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Kelly M. Lange, M.A, L.L.P

Psychologist in Plymouth, MI. Organization (NPI-2).

NPI number1194366807
StatusActive
Last updated in NPPESOct 3, 2019

Details

NPI
1194366807
Entity type
Organization (NPI-2)
Legal business name
Kelly M. Lange, M.A, L.L.P
Organization subpart
No
Enumeration date
Oct 3, 2019
Last updated
Oct 3, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103T00000X Psychologist––Yes

Practice location

496 W Ann Arbor Trl Ste 106
Plymouth, MI 48170-6262

Phone 734-754-1172

Mailing address

41422 Strawberry Ct
Canton, MI 48188-5244

Phone 734-754-1172

Authorized official

Kelly Marie Lange
Clinician
7347541172

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