Provider Demographics
NPI:1376940650
Name:LANGE-CASILLAS, JOSHUA JOSEPH
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JOSEPH
Last Name:LANGE-CASILLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 CHOCTAW ST
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-1626
Mailing Address - Country:US
Mailing Address - Phone:580-327-1112
Mailing Address - Fax:
Practice Address - Street 1:604 CHOCTAW ST
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-1626
Practice Address - Country:US
Practice Address - Phone:580-327-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional