Provider Demographics
NPI:1689695777
Name:TOUCHATT, RANDELL G (LCSW PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDELL
Middle Name:G
Last Name:TOUCHATT
Suffix:
Gender:M
Credentials:LCSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15504 S MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-8626
Mailing Address - Country:US
Mailing Address - Phone:405-895-6101
Mailing Address - Fax:405-895-9933
Practice Address - Street 1:8241 S WALKER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9401
Practice Address - Country:US
Practice Address - Phone:405-895-6101
Practice Address - Fax:405-895-9933
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK462101YA0400X
TX308261041C0700X
OK19871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100716180BMedicaid