Provider Demographics
NPI:1851657266
Name:RANDOL, ROBYN RENEE
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:RENEE
Last Name:RANDOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11712 NW 117TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8146
Mailing Address - Country:US
Mailing Address - Phone:405-694-5889
Mailing Address - Fax:
Practice Address - Street 1:11712 NW 117TH ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8146
Practice Address - Country:US
Practice Address - Phone:405-694-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor