Provider Demographics
NPI:1316562697
Name:RANDALL, JAMES OLIVER
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:OLIVER
Last Name:RANDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16351 NE 13TH PL APT A103
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-3695
Mailing Address - Country:US
Mailing Address - Phone:425-761-0142
Mailing Address - Fax:
Practice Address - Street 1:1412 140TH PL NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3915
Practice Address - Country:US
Practice Address - Phone:425-747-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health