Individual
DR. MARQUE E RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1300 N 200 E, STE 114-A, LOGAN, UT 84341-2398
(435) 753-2687
Mailing address
1300 N 200 E, STE 114-A, LOGAN, UT 84341-2398
(435) 753-2687
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
52285242501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107019240103
IHC
UT
01
—
52285242501001
BCBS
UT
01
—
85006
PEHP
UT
01
—
885077
DMBA
UT
Enumeration date
07/19/2006
Last updated
08/31/2007
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