MEDICARE: DR. RANDELL G TOUCHATT LCSW PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	462	OK
2	1041C0700X	Clinical Social Worker	30826	TX
3	1041C0700X	Clinical Social Worker	1987	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689695777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDELL G TOUCHATT LCSW PHD

Provider Business Mailing Address
First Line	:	15504 S MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-8626
Country	:	US
Telephone Number	:	405-895-6101
Fax Number	:	405-895-9933

Provider Business Practice Location Address
First Line	:	8241 S WALKER AVE
Second Line	:	SUITE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9401
Country	:	US
Telephone Number	:	405-895-6101
Fax Number	:	405-895-9933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	08/03/2022

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