Healthcare Provider Details

I. General information

NPI: 1528204971
Provider Name (Legal Business Name): DAVID RANDALL HOBBS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 N PORTLAND AVE
OKLAHOMA CITY OK
73112-6171
US

IV. Provider business mailing address

3600 LEA CT
EDMOND OK
73013-8127
US

V. Phone/Fax

Practice location:
  • Phone: 405-605-3093
  • Fax:
Mailing address:
  • Phone: 405-474-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3140
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: