Provider Demographics
NPI:1235463597
Name:STEVENS, RANDI MARIE (MED, LPC, CRC)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:MARIE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MED, LPC, CRC
Other - Prefix:MISS
Other - First Name:RANDI
Other - Middle Name:MARIE
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1819 W GRANGE AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8554
Mailing Address - Country:US
Mailing Address - Phone:208-625-1343
Mailing Address - Fax:
Practice Address - Street 1:1621 N 3RD ST STE 1100
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3381
Practice Address - Country:US
Practice Address - Phone:208-625-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4085101YP2500X
ID00108377225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor