Provider Demographics
NPI:1518362110
Name:VOSS, RANDAL SEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:SEAN
Last Name:VOSS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5903 SW MACASIN AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-7052
Mailing Address - Country:US
Mailing Address - Phone:903-458-0788
Mailing Address - Fax:
Practice Address - Street 1:5903 SW MACASIN AVE
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-7052
Practice Address - Country:US
Practice Address - Phone:903-458-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24250101YM0800X, 1041C0700X
AR13257-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health