Provider Demographics
NPI:1225901192
Name:RANDALL, JACOB C (LMSW)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:C
Last Name:RANDALL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 S NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-5130
Mailing Address - Country:US
Mailing Address - Phone:918-382-3442
Mailing Address - Fax:
Practice Address - Street 1:311 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3208
Practice Address - Country:US
Practice Address - Phone:918-582-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK203011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical