Doctor Name: | MR. RANDALL C RANDALL |
NPI Number: | 1730106212 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.C.S.W. |
License Number: | 4809685-3501 |
Business Practice Address: | 5242 S 4820 W Kearns, UT - 841186422 |
Business Phone Number: | 8019664251 |
Business Fax Number: | 8019664289 |
Mailing Address: | 1145 Brickyard Rd Apt 1203, SALT LAKE CITY |
State: | UT |
Postal Code: | 841062537 |
Phone Number: | 8015803823 |
Fax Number: | |
NPI Enumeration Date: | 07/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 4809685-3501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |