Individual
HEATHER JEAN RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1500 W ASHLAND ST, NEVADA, MO 64772-1710
(417) 667-2666
Mailing address
1034 N CEDAR ST, NEVADA, MO 64772-1437
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2004032818
MO
Other
Enumeration date
02/08/2007
Last updated
07/08/2007
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