Provider Demographics
NPI:1316255599
Name:RANDOL, JASIE KAYE (BS, BHRS)
Entity type:Individual
Prefix:
First Name:JASIE
Middle Name:KAYE
Last Name:RANDOL
Suffix:
Gender:F
Credentials:BS, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-4653
Mailing Address - Country:US
Mailing Address - Phone:580-233-5900
Mailing Address - Fax:
Practice Address - Street 1:129 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4653
Practice Address - Country:US
Practice Address - Phone:580-233-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK87911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical