Healthcare Provider Details

I. General information

NPI: 1477951663
Provider Name (Legal Business Name): MAWOH LANGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2014
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14018 N WESTERN AVE
EDMOND OK
73013-1977
US

IV. Provider business mailing address

1514 E LINDSEY ST APT M
NORMAN OK
73071-2246
US

V. Phone/Fax

Practice location:
  • Phone: 405-302-2522
  • Fax: 405-302-2522
Mailing address:
  • Phone: 405-412-7334
  • Fax: 405-412-7334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: