Provider Demographics
NPI:1598041931
Name:RANDOLPH, GERRI RENAE (BHRS)
Entity Type:Individual
Prefix:MRS
First Name:GERRI
Middle Name:RENAE
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 LONETREE DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-1170
Mailing Address - Country:US
Mailing Address - Phone:405-919-6236
Mailing Address - Fax:
Practice Address - Street 1:6418 N SANTA FE AVE STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9100
Practice Address - Country:US
Practice Address - Phone:405-242-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst