Provider Demographics
NPI:1093078586
Name:BARTHOLOMEW, RANDAL LEE (CAS)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:LEE
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0618
Mailing Address - Country:US
Mailing Address - Phone:530-243-7470
Mailing Address - Fax:
Practice Address - Street 1:1237 CALIFORNIA ST.
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-243-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAS 03-046502251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACAS 03-046502OtherCAS 03-046502