Anderson, Randall Alan

Anderson, Randall Alan is an individual health care provider with primary practice located at 110 Skyline Dr , Russellville AR 72801-3362. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychoanalyst, Behavioral Health & Social Service Providers / Counseling. Behavioral Health & Social Service Providers / Counseling is his primary health care specialty. Anderson, Randall Alan can be contacted via phone (479) 968-1298.

Contact Information

Primary practice address
110 Skyline Dr Russellville AR 72801-3362
Phone: (479) 968-1298
Fax: (479) 968-6053
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychoanalyst 102L00000X 88-12EI Arkansas
Behavioral Health & Social Service Providers / Counseling 103TC1900X 88-12EI Arkansas

Profile Details

NPI number 1508135625
LBN Legal business name Anderson, Randall Alan
Credentials LPE-I
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 19th, 2011
Last updated Apr 21st, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508135625 NPPES
Arkansas MEDICAID 228376719

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