Provider Demographics
NPI:1275737116
Name:RANDOLPH, JOSEPH BRANNON (MS, MBA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BRANNON
Last Name:RANDOLPH
Suffix:
Gender:M
Credentials:MS, MBA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 ISAACS ORCHARD RD
Mailing Address - Street 2:STE. 215
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6545
Mailing Address - Country:US
Mailing Address - Phone:479-725-3813
Mailing Address - Fax:479-419-4046
Practice Address - Street 1:6801 ISAACS ORCHARD RD
Practice Address - Street 2:STE. 215
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6545
Practice Address - Country:US
Practice Address - Phone:479-725-3813
Practice Address - Fax:479-419-4046
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPO309038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR181106719Medicaid