Individual provider Active NPI

Kim Holtan Lang, M.A., LCMHC

  • Mental Health Counselor
  • Burlington, VT
National Provider Identifier
1891921359
Registry record updated Jun 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
0680050790 Issued in VT
Practice address
86 Lake St
Burlington, VT 05401-5297
Phone
(802) 865-3450
Fax
(802) 860-5011
NPI assigned
Jun 10, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 0680050790 VT Primary

Addresses

Primary practice location

86 Lake St
Burlington, VT 05401-5297

Mailing address

86 Lake St
Burlington, VT 05401-5297
Phone (802) 865-3450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240123000317 VT Practitioner - Mental Health Counselor 9931570140 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Undefined Non-Physician Type (Specify)
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

86 Lake St
Burlington, VT 05401-5297

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
0680050790VTMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Matrix Health Systems P.C. CurrentSince Jan 1, 2024 Accepting new patients

Locations

86 Lake St
Ste 110
Burlington, VT 05401
Phone (802) 288-0584

86 Lake St
Burlington, VT 05401
Phone (802) 862-8595

112 Lake St
Burlington, VT 05401
Phone (802) 999-4739

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244592000000",
    "number": "1891921359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 LAKE ST",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054015297",
            "telephone_number": "802-865-3450",
            "fax_number": "802-860-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 LAKE ST",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054015297",
            "telephone_number": "802-865-3450",
            "fax_number": "802-860-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANG",
        "first_name": "KIM",
        "middle_name": "HOLTAN",
        "name_prefix": "Ms.",
        "credential": "M.A., LCMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-10",
        "last_updated": "2009-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VT",
            "license": "0680050790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

Verify at the official NPI Registry.