Individual
JOHN CARL RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
2273 S VISTA AVE, STE 190, BOISE, ID 83705-7341
(208) 343-2737
(208) 342-3238
Mailing address
3132 W IRENE ST, BOISE, ID 83703-5874
(315) 278-6609
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-32190
ID
Other
Enumeration date
06/14/2012
Last updated
06/14/2012
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