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General NPI Number Information
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NPI Number | 1225901192
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Entity Type | Individual
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Provider Name | JACOB C RANDALL LMSW
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Gender | Male
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Dates
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Enumeration Date | 09/26/2025
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 311 S MADISON AVE
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City | TULSA
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State | OK
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Zip | 74120-3208
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Country | US
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Telephone | 918-582-0061
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Fax |
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Provider Business Mailing Address
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Address Line | 1232 S NEW HAVEN AVE
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City | TULSA
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State | OK
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Zip | 74112-5130
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Country | US
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Telephone | 918-382-3442
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 20301
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License Number State | OK
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