Basic Information
| Provider Information | |||||||||
| NPI: | 1063537751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOYER | ||||||||
| FirstName: | RANDI | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | B.S.W., BHRS, CM-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 523 N BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | WEATHERFORD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730964909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802255136 | ||||||||
| FaxNumber: | 5802255138 | ||||||||
| Practice Location | |||||||||
| Address1: | 3080 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | ELK CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736444323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802255136 | ||||||||
| FaxNumber: | 5802255138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.