Provider Demographics
NPI:1043533797
Name:CROWNOVER, RANDY LOUIS (LMFT)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:LOUIS
Last Name:CROWNOVER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 FIRST LIGHT LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-0819
Mailing Address - Country:US
Mailing Address - Phone:405-819-1349
Mailing Address - Fax:866-351-2284
Practice Address - Street 1:4733 FIRST LIGHT LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-0819
Practice Address - Country:US
Practice Address - Phone:405-819-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK911106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist