Provider Demographics
NPI:1528093523
Name:LANGELLE, CHARYLE (PHD)
Entity type:Individual
Prefix:
First Name:CHARYLE
Middle Name:
Last Name:LANGELLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CHARYLE
Other - Middle Name:
Other - Last Name:THORNWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1015 S BROADWAY
Mailing Address - Street 2:STE 18
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4667
Mailing Address - Country:US
Mailing Address - Phone:701-857-8500
Mailing Address - Fax:701-857-8555
Practice Address - Street 1:1015 S BROADWAY
Practice Address - Street 2:STE 18
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4667
Practice Address - Country:US
Practice Address - Phone:701-857-8500
Practice Address - Fax:701-857-8555
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND340103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN19862OtherRR MEDICARE
ND054517Medicaid
ND019862OtherBCBSND
ND$$$$$$$$$OtherTRICARE
NDN19862Medicare PIN