Provider Demographics
NPI:1356647291
Name:BEAUBOUEF, RANDALL (MSW)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:BEAUBOUEF
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1304
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82073-1304
Mailing Address - Country:US
Mailing Address - Phone:307-742-6222
Mailing Address - Fax:307-742-9905
Practice Address - Street 1:2909 BENT AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2742
Practice Address - Country:US
Practice Address - Phone:307-742-6222
Practice Address - Fax:307-742-9905
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical