Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PS008789L | PA |
N | 103TC0700X | Clinical Psychologist | PS008789L | PA |
N | 102L00000X | Psychologist | PS008789L | PA |
N | 103T00000X | Psychologist | PS008789L | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1208 | OK |
Y | 103G00000X | Clinical Psychologist | 1208 | OK |
Y | 103TC0700X | Clinical Psychologist | 1208 | OK |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS008789L | PA |
N | 103TH0100X | Health Service | 1208 | OK |
N | 103TS0200X | School Psychologist | 1208 | OK |
NPI | 1255380945 |
---|---|
Provider Name | Dr. Stephen M Lange |
First Address | Lawton, OK 73501 |
Second Address | Lawton, OK 73501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 08/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112460809 | UNITED BEHAVIORAL HEALTH (01) | PA |
1501224 | HIGHMARK BLUE SHIELD (01) | PA |
50011084 | CAPITAL BLUE CROSS (01) | PA |
550010003163 | PACIFIC BEHAVIORAL HC (01) | PA |