Provider Demographics
NPI:1578944203
Name:DEFRANGE, ALISHA MIRANDA (BHCM II)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:MIRANDA
Last Name:DEFRANGE
Suffix:
Gender:F
Credentials:BHCM II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 720
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525
Mailing Address - Country:US
Mailing Address - Phone:580-889-3424
Mailing Address - Fax:580-889-4050
Practice Address - Street 1:706 SOUTH GREATHOUSE DRIVE
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525
Practice Address - Country:US
Practice Address - Phone:580-889-3424
Practice Address - Fax:580-889-4050
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73-1311206Medicaid