Healthcare Provider Details

I. General information

NPI: 1255380945
Provider Name (Legal Business Name): STEPHEN M LANGE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAWTON CORRECTIONAL FACILITY 8607 SE FLOWERMOUND ROAD
LAWTON OK
73501
US

IV. Provider business mailing address

LAWTON CORRECTIONAL FACILITY 8607 SE FLOWERMOUND ROAD
LAWTON OK
73501
US

V. Phone/Fax

Practice location:
  • Phone: 580-280-7128
  • Fax: 405-716-4810
Mailing address:
  • Phone: 580-280-7128
  • Fax: 405-716-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS008789L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS008789L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS008789L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1208
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1208
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1208
License Number StateOK
# 7
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1208
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: