Individual provider Active NPI

Susan Arnold Lange, PH. D.

  • Psychologist
  • Fort Worth, TX
National Provider Identifier
1689782260
Registry record updated Apr 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2-3082 Issued in TX
Practice address
9500 Ray White Rd
200
Fort Worth, TX 76244-9104
Phone
(817) 745-4612
Fax
(817) 479-7313
NPI assigned
Aug 25, 2006
Last updated
Apr 6, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2-3082 TX Primary

Addresses

Primary practice location

9500 Ray White Rd
200
Fort Worth, TX 76244-9104

Mailing address

9500 Ray White Rd
Ste 200
Fort Worth, TX 76244-9104
Phone (817) 745-4612

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2-3082TXMDPsychologist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270512000000",
    "number": "1689782260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 RAY WHITE RD",
            "address_2": "STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762449104",
            "telephone_number": "817-745-4612",
            "fax_number": "817-479-7313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 RAY WHITE RD",
            "address_2": "200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762449104",
            "telephone_number": "817-745-4612",
            "fax_number": "817-479-7313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANGE",
        "first_name": "SUSAN",
        "middle_name": "ARNOLD",
        "name_prefix": "Dr.",
        "credential": "PH. D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2010-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "2-3082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.