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General NPI Number Information
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NPI Number | 1215261219
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Entity Type | Organization
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Legal Business Name | FAITH FAMILY DEVELOPMENTAL CENTER
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | RR 1 BOX 131C
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City | EUFAULA
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State | OK
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Zip | 74432-9223
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Country | US
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Telephone | 918-452-3512
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Fax | 918-452-3512
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Provider Business Mailing Address
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Address Line | RR 1 BOX 131C
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City | EUFAULA
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State | OK
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Zip | 74432-9223
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Country | US
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Telephone | 918-452-3512
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Fax | 918-452-3512
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. RANDY DUANE RANDLEMAN
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Credential | PH.D.
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Telephone | 918-452-3512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 825
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License Number State | OK
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