Provider Demographics
NPI:1255672127
Name:RANDALL, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:RANDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SELMI DR
Mailing Address - Street 2:SUITE601
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-6701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1130 SELMI DR
Practice Address - Street 2:SUITE601
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-6701
Practice Address - Country:US
Practice Address - Phone:775-420-5396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-02
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst