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Individual

JOHN TAYLOR RANDOLPH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPC, LADC

Contact information

Practice address
605 W OXFORD AVE, ENID, OK 73701-1208
(580) 233-7220
(580) 237-7550
Mailing address
2820 W RANDOLPH AVE, ENID, OK 73703-4035
(580) 233-2487
(580) 237-7550

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
647
OK
101YP2500X
Professional Counselor
Primary
3641
OK

Other

Enumeration date
06/29/2009
Last updated
06/29/2009
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