Individual
CHAD R RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED.
Contact information
Practice address
140 PROSPECT AVE STE T, KIRKWOOD, MO 63122-6024
(314) 200-4482
Mailing address
140 PROSPECT AVE STE T, KIRKWOOD, MO 63122-6024
(314) 200-4482
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2009038524
MO
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
01/08/2009
Last updated
11/11/2020
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