Doctor Name: | KATHE MCGEHEE RANDLE |
NPI Number: | 1518944917 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC, LAC |
License Number: | 593LAC |
Business Practice Address: | 28 Litler Ln Polson, MT - 598609654 |
Business Phone Number: | 4068833058 |
Business Fax Number: | 4068834710 |
Mailing Address: | 28 Litler Ln, POLSON |
State: | MT |
Postal Code: | 598609654 |
Phone Number: | 4068833058 |
Fax Number: | 4068834710 |
NPI Enumeration Date: | 12/27/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 593LAC |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |