Individual
DR. STEPHEN M LANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
LAWTON CORRECTIONAL FACILITY, 8607 SE FLOWERMOUND ROAD, LAWTON, OK 73501
(580) 280-7128
(405) 716-4810
Mailing address
LAWTON CORRECTIONAL FACILITY, 8607 SE FLOWERMOUND ROAD, LAWTON, OK 73501
(580) 280-7128
(405) 716-4810
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PS008789L
PA
103T00000X
Psychologist
PS008789L
PA
103TA0400X
Addiction (Substance Use Disorder) Psychologist
1208
OK
103TC0700X
Clinical Psychologist
Primary
1208
OK
103TC2200X
Clinical Child & Adolescent Psychologist
PS008789L
PA
103TH0100X
Health Service Psychologist
1208
OK
103TS0200X
School Psychologist
1208
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112460809
UNITED BEHAVIORAL HEALTH
PA
01
—
1501224
HIGHMARK BLUE SHIELD
PA
01
—
50011084
CAPITAL BLUE CROSS
PA
01
—
550010003163
PACIFIC BEHAVIORAL HC
PA
Enumeration date
05/09/2006
Last updated
12/08/2016
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