Provider Demographics
NPI:1902899123
Name:KREHBIEL, RANDALL K (MSW LSCSW DCSW)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:K
Last Name:KREHBIEL
Suffix:
Gender:M
Credentials:MSW LSCSW DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 MESA WAY
Mailing Address - Street 2:STE B
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2346
Mailing Address - Country:US
Mailing Address - Phone:785-838-4400
Mailing Address - Fax:785-838-9268
Practice Address - Street 1:3210 MESA WAY
Practice Address - Street 2:STE B
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2346
Practice Address - Country:US
Practice Address - Phone:785-838-4400
Practice Address - Fax:785-838-9268
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW #3771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069702Medicare ID - Type Unspecified