Provider Demographics
NPI:1215077318
Name:STANKO, RANDOLPH (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:
Last Name:STANKO
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:680 SECOND STREET
Mailing Address - City:OURAY
Mailing Address - State:CO
Mailing Address - Zip Code:81427-0268
Mailing Address - Country:US
Mailing Address - Phone:970-325-7380
Mailing Address - Fax:970-325-7392
Practice Address - Street 1:680 SECOND STREET
Practice Address - Street 2:
Practice Address - City:OURAY
Practice Address - State:CO
Practice Address - Zip Code:81427-0698
Practice Address - Country:US
Practice Address - Phone:970-325-7392
Practice Address - Fax:970-325-7392
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT 0193106H00000X
CAMFT 23216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84-1266851-001OtherROCK MOUNTAIN HEALTH PLAN