Individual
JESSICA RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, PA
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3100
Mailing address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3100
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
5388
OK
101YP2500X
Professional Counselor
5388
OK
363AM0700X
Medical Physician Assistant
Primary
3205
OK
Other
Enumeration date
05/28/2010
Last updated
05/05/2026
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