Provider Demographics
NPI:1730498767
Name:RANDLEMAN, RYAN DEAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DEAN
Last Name:RANDLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 HILLCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:HENRYETTA
Mailing Address - State:OK
Mailing Address - Zip Code:74437
Mailing Address - Country:US
Mailing Address - Phone:918-650-3832
Mailing Address - Fax:
Practice Address - Street 1:9150 COTTONWOOD RD
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-1563
Practice Address - Country:US
Practice Address - Phone:918-650-3832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKS081746945103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst