Provider Demographics
NPI:1851662860
Name:PHILLIPS, RANDALL AUSTIN JR
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:AUSTIN
Last Name:PHILLIPS
Suffix:JR
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 1:301 NW 63RD ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7907
Mailing Address - Country:US
Mailing Address - Phone:405-418-3865
Mailing Address - Fax:
Practice Address - Street 1:301 NW 63RD ST
Practice Address - Street 2:SUITE 301
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7907
Practice Address - Country:US
Practice Address - Phone:405-418-3865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker