Provider Demographics
NPI:1275990913
Name:LUMM, -RANDOLPH STEPHEN
Entity Type:Individual
Prefix:MR
First Name:-RANDOLPH
Middle Name:STEPHEN
Last Name:LUMM
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RANDOLPH
Other - Middle Name:
Other - Last Name:LUMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15433 W SHANGRI LA RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5388
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15433 W SHANGRI LA RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5388
Practice Address - Country:US
Practice Address - Phone:602-980-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical