Provider Demographics
NPI:1174839427
Name:CRAVEN, RANDALL SEAN (LPC, CAC II)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:SEAN
Last Name:CRAVEN
Suffix:
Gender:M
Credentials:LPC, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 DUNKIRK WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-6543
Mailing Address - Country:US
Mailing Address - Phone:720-331-4878
Mailing Address - Fax:303-371-8250
Practice Address - Street 1:12101 E 2ND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8327
Practice Address - Country:US
Practice Address - Phone:720-331-4878
Practice Address - Fax:303-371-8250
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7094101YA0400X
CO5687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)