Individual
KYLE RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1470 NW 4TH ST, REDMOND, OR 97756-1366
(541) 316-7520
Mailing address
PO BOX 1710, REDMOND, OR 97756-0516
(541) 516-4097
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-22-1471
OR
Other
Enumeration date
04/14/2022
Last updated
04/14/2022
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