Provider Demographics
NPI:1982420782
Name:RANDALL, JOCELYN GAWARAN (LICSW)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:GAWARAN
Last Name:RANDALL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 156TH DR NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5230
Mailing Address - Country:US
Mailing Address - Phone:206-851-7623
Mailing Address - Fax:
Practice Address - Street 1:5412 156TH DR NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5230
Practice Address - Country:US
Practice Address - Phone:206-851-7623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00009439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health