Provider Demographics
NPI:1518944917
Name:RANDLE, KATHE MCGEHEE (LCPC, LAC)
Entity Type:Individual
Prefix:
First Name:KATHE
Middle Name:MCGEHEE
Last Name:RANDLE
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LITLER LN
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-9654
Mailing Address - Country:US
Mailing Address - Phone:406-883-3058
Mailing Address - Fax:406-883-4710
Practice Address - Street 1:28 LITLER LN
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-9654
Practice Address - Country:US
Practice Address - Phone:406-883-3058
Practice Address - Fax:406-883-4710
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT593LAC101YA0400X
MT537LCPC101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256156Medicaid