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Individual

BREANNA ROSE RANDALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
932 W STATE HIGHWAY 152, MUSTANG, OK 73064-2301
(405) 577-5477
Mailing address
932 W STATE HIGHWAY 152, MUSTANG, OK 73064-2301
(405) 577-5477

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
11319
OK
171M00000X
Case Manager/Care Coordinator

Other

Enumeration date
08/29/2018
Last updated
02/17/2023
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