Provider Demographics
NPI:1528689676
Name:RANDEL, YVONNE MARIE (LPC, LSOTP, LCDC)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:MARIE
Last Name:RANDEL
Suffix:
Gender:F
Credentials:LPC, LSOTP, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 COUNTY ROAD 4011
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-7386
Mailing Address - Country:US
Mailing Address - Phone:281-806-1836
Mailing Address - Fax:
Practice Address - Street 1:519 COUNTY ROAD 4011
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-7386
Practice Address - Country:US
Practice Address - Phone:281-806-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10512101YA0400X
TX67331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty