Healthcare Provider Details

I. General information

NPI: 1376511964
Provider Name (Legal Business Name): RANDALL WAYNE JARMAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 E 51ST ST SUITE #400
TULSA OK
74135-7461
US

IV. Provider business mailing address

10707 E 97TH PL N
OWASSO OK
74055-4345
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-0859
  • Fax: 918-293-1031
Mailing address:
  • Phone: 918-272-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number647
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: