Individual
BETHANY RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHP
Contact information
Practice address
8915 SW CENTER ST, TIGARD, OR 97223-6307
(503) 726-3764
Mailing address
7231 SE CARLTON ST, PORTLAND, OR 97206-6429
(503) 267-7402
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
372600000X
Adult Companion
—
—
Other
Enumeration date
09/24/2013
Last updated
03/17/2018
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