Organization
CONVALESCE
Active
Organization
CONVALESCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIANE LANGE MS/LPC (CLINICAL DIRECTOR)
(405) 430-8917
Entity
Organization
Contact information
Practice address
626 N BROADWAY ST, MOORE, OK 73160-4814
(405) 430-8917
Mailing address
626 N BROADWAY ST, MOORE, OK 73160-4814
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
5734
OK
Other
Enumeration date
04/25/2016
Last updated
04/25/2016
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