Provider Demographics
NPI:1255380945
Name:LANGE, STEPHEN M (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:LANGE
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:LAWTON CORRECTIONAL FACILITY
Mailing Address - Street 2:8607 SE FLOWERMOUND ROAD
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501
Mailing Address - Country:US
Mailing Address - Phone:580-280-7128
Mailing Address - Fax:405-716-4810
Practice Address - Street 1:LAWTON CORRECTIONAL FACILITY
Practice Address - Street 2:8607 SE FLOWERMOUND ROAD
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501
Practice Address - Country:US
Practice Address - Phone:580-280-7128
Practice Address - Fax:405-716-4810
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2016-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAPS008789L103G00000X, 103TC2200X, 103T00000X
OK1208103TA0400X, 103TC0700X, 103TH0100X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112460809OtherUNITED BEHAVIORAL HEALTH
PA1501224OtherHIGHMARK BLUE SHIELD
PA550010003163OtherPACIFIC BEHAVIORAL HC
PA50011084OtherCAPITAL BLUE CROSS