Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | 4855 | OK |
N | 101YS0200X | School Counselor | ||
Y | 103TS0200X | School Psychologist |
NPI | 1083875769 |
---|---|
Provider Name | Mary Carmen Randleman |
First Address | Muskogee, OK 74402-2113 |
Second Address | Checotah, OK 74426-3815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 16/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200378480 | (05) | OK |
200456660 A | (05) | OK |