Provider Demographics
NPI:1740150820
Name:RANDOLPH, COURTNEY BLISS (LPCC, LPC, LADC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:BLISS
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:LPCC, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 ELIZABETH WAY APT 221
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7400
Mailing Address - Country:US
Mailing Address - Phone:612-443-6166
Mailing Address - Fax:
Practice Address - Street 1:690 ELIZABETH WAY APT 221
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-7400
Practice Address - Country:US
Practice Address - Phone:612-443-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-05
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305869101YA0400X
WI11669-125101YM0800X
MN4209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)