Provider Demographics
NPI:1477951663
Name:LANGE, MAWOH
Entity Type:Individual
Prefix:
First Name:MAWOH
Middle Name:
Last Name:LANGE
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 1:1514 E LINDSEY ST APT M
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-2246
Mailing Address - Country:US
Mailing Address - Phone:405-412-7334
Mailing Address - Fax:405-412-7334
Practice Address - Street 1:14018 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1977
Practice Address - Country:US
Practice Address - Phone:405-302-2522
Practice Address - Fax:405-302-2522
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-20
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional