Individual
MR. RANDALL C RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.C.S.W.
Contact information
Practice address
5242 S 4820 W, KEARNS, UT 84118-6422
(801) 966-4251
(801) 966-4289
Mailing address
1145 BRICKYARD RD APT 1203, SALT LAKE CITY, UT 84106-2537
(801) 580-3823
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4809685-3501
UT
Other
Enumeration date
07/17/2006
Last updated
07/08/2007
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