Individual
MARK STEVEN RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD HSPP
Contact information
Practice address
8075 NORTH SHADELAND AVENUE, INDIANAPOLIS, IN 46256-2693
(317) 621-8000
Mailing address
8180 CLEARVISTA PARKWAY, SUITE 230 ATTN SHERRY MUELLER, INDIANAPOLIS, IN 46256-4649
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
20041703A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200305690
—
IN
01
—
680016092
RAILROAD MEDICARE
IN
Enumeration date
08/11/2005
Last updated
03/10/2011
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