Provider Demographics
NPI:1306930425
Name:RANDOLPH-ELGIN, TANYA MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:MICHELLE
Last Name:RANDOLPH-ELGIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROMSBURG
Mailing Address - State:NE
Mailing Address - Zip Code:68666-3015
Mailing Address - Country:US
Mailing Address - Phone:402-764-8183
Mailing Address - Fax:
Practice Address - Street 1:302 E 4TH ST
Practice Address - Street 2:
Practice Address - City:STROMSBURG
Practice Address - State:NE
Practice Address - Zip Code:68666-4417
Practice Address - Country:US
Practice Address - Phone:402-764-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE510103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE559-692OtherVALUE OPTIONS
NE241839OtherMIDLANDS CHOICE
NE08468OtherBLUE CROSS BLUE SHIELD
NE6866600OtherTRIWEST
NE276113Medicare ID - Type Unspecified
NEP73558Medicare UPIN