Provider Demographics
NPI:1154873552
Name:STEVEN JAMES RANDOLPH LCSW-ACSW
Entity type:Organization
Organization Name:STEVEN JAMES RANDOLPH LCSW-ACSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-ACSW
Authorized Official - Phone:405-476-5487
Mailing Address - Street 1:419 W GRAY ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7117
Mailing Address - Country:US
Mailing Address - Phone:405-329-7300
Mailing Address - Fax:405-364-5379
Practice Address - Street 1:23 E 9TH ST
Practice Address - Street 2:STE 321
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6943
Practice Address - Country:US
Practice Address - Phone:405-476-5487
Practice Address - Fax:405-521-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty