Healthcare Provider Details

I. General information

NPI: 1083875769
Provider Name (Legal Business Name): MARY CARMEN RANDLEMAN M.ED., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: M CARMEN RANDLEMAN

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N OAK ST STE 5
SALLISAW OK
74955-4602
US

IV. Provider business mailing address

PO BOX 1084
SALLISAW OK
74955-1084
US

V. Phone/Fax

Practice location:
  • Phone: 918-724-6449
  • Fax: 918-208-0687
Mailing address:
  • Phone: 918-724-6449
  • Fax: 918-208-0687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number229640
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4855
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: