Provider Demographics
NPI:1518230952
Name:RANDALL, SAUL JOSHUA (MS CPCI NCC)
Entity Type:Individual
Prefix:MR
First Name:SAUL
Middle Name:JOSHUA
Last Name:RANDALL
Suffix:
Gender:M
Credentials:MS CPCI NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7837 SILVER PLATEAU AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-2657
Mailing Address - Country:US
Mailing Address - Phone:702-672-1243
Mailing Address - Fax:
Practice Address - Street 1:3017 W CHARLESTON BLVD
Practice Address - Street 2:SUITE #70
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1941
Practice Address - Country:US
Practice Address - Phone:702-823-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
NVCI0181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner