Healthcare Provider Details

I. General information

NPI: 1487572772
Provider Name (Legal Business Name): JOHANNA LANGE MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 E MEMORIAL RD STE 104
EDMOND OK
73013-6470
US

IV. Provider business mailing address

2801 E MEMORIAL RD STE 104
EDMOND OK
73013-6470
US

V. Phone/Fax

Practice location:
  • Phone: 405-355-8322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12247
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: