Provider Demographics
NPI:1164634119
Name:CASWELL, RANDY K (LPC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:K
Last Name:CASWELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11715 S HOLLEY CT
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-5053
Mailing Address - Country:US
Mailing Address - Phone:918-812-3953
Mailing Address - Fax:
Practice Address - Street 1:1808 S HICKORY ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-6219
Practice Address - Country:US
Practice Address - Phone:918-812-3953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC 2057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health