| Deborah Randolph, Lcsw, Pc | |
|
1441 Nw 150th St Edmond OK 73013-1305 | |
| (405) 509-1384 | |
| (405) 563-9416 |
| Full Name | Deborah Randolph, Lcsw, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 1441 Nw 150th St, Edmond, Oklahoma |
| Authorized Official Name and Position | Deborah Kay Randolph (PRESIDENT) |
| Authorized Official Contact | 4055091384 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deborah Randolph, Lcsw, Pc 1441 Nw 150th St Edmond OK 73013-1305 Ph: (405) 509-1384 | Deborah Randolph, Lcsw, Pc 1441 Nw 150th St Edmond OK 73013-1305 Ph: (405) 509-1384 |
| NPI Number | 1306124961 |
|---|---|
| Provider Enumeration Date | 08/01/2011 |
| Last Update Date | 08/28/2013 |
| Medicare PECOS PAC ID | 2365604188 |
|---|---|
| Medicare Enrollment ID | O20120424000242 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306124961 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 1766 (Oklahoma) | Primary |
| Provider Name | Deborah K Randolph |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609806934 PECOS PAC ID: 8729029814 Enrollment ID: I20050711000664 |
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