Individual
MRS. LAURIE JEAN RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC, RN
Contact information
Practice address
1325 WYOMING ST, MISSOULA, MT 59801-1725
(406) 532-9800
Mailing address
T-9 FORT MISSOULA, MISSOULA, MT 59804-7202
(406) 532-8400
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1239
MT
163W00000X
Registered Nurse
16052
MT
Other
Enumeration date
05/11/2009
Last updated
05/11/2009
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