Provider Demographics
NPI:1215267208
Name:BERNER, RANDALL S (LPCC)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:S
Last Name:BERNER
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13116 VERBENA PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6369
Mailing Address - Country:US
Mailing Address - Phone:505-449-8291
Mailing Address - Fax:
Practice Address - Street 1:481 SANDIA LOOP
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-7076
Practice Address - Country:US
Practice Address - Phone:505-771-5131
Practice Address - Fax:505-867-7099
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0077121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional