Provider Demographics
NPI:1700028479
Name:GARDENHIRE, RANDY HUGH (MS)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:HUGH
Last Name:GARDENHIRE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-0309
Mailing Address - Country:US
Mailing Address - Phone:580-298-3001
Mailing Address - Fax:580-298-5357
Practice Address - Street 1:215 W LINN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-5837
Practice Address - Country:US
Practice Address - Phone:405-321-0022
Practice Address - Fax:405-360-4918
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health