Ethan Randall

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8189 Issued in OK

Practice address

308 E Downing St
Tahlequah, OK 74464-3014

Phone

(918) 931-3995

NPI assigned

Dec 29, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tranquil Minds LLC

  • Clinical Social Worker
  • Vancouver, WA
  • NPI 1255170403
  NPD Authorized official
• Tranquil Roots LLC

  • Clinical Social Worker
  • Seattle, WA
  • NPI 1063396133
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1508526773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6947 N 460 RD",
            "city": "HULBERT",
            "state": "OK",
            "postal_code": "744413250",
            "telephone_number": "918-931-3995",
            "fax_number": "918-931-3994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 E DOWNING ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643014",
            "telephone_number": "918-931-3995"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "217 N Water Ave",
            "address_purpose": "LOCATION",
            "city": "Tahlequah",
            "state": "OK",
            "postal_code": "744642825",
            "country_code": "US",
            "telephone_number": "888-692-6590",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "ETHAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-29",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "8189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Edward Rader, D.D.S.
• Juliann Maria Rados, OD
• Heather Ragsdale
• Raji M Gill DO PC
• Carrie Anne Ramos
• Jessica Randolph, LPC, PA
• Calli Cheyanne Raper
• Samiya Rashid, DO
• Christina Ratterree
• Sejal Maria Rawls

• Clinical Social Worker in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• Clinical Social Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.