Provider Demographics
NPI:1447972278
Name:LANGFORD, KIMBERLY (LAC, LASAC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:LAC, LASAC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:LOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:724 N MONTEZUMA ST STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2066
Mailing Address - Country:US
Mailing Address - Phone:928-308-3569
Mailing Address - Fax:
Practice Address - Street 1:724 N MONTEZUMA ST STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2066
Practice Address - Country:US
Practice Address - Phone:928-308-3569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15353101YA0400X
AZ21174101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)