Provider Demographics
NPI:1568753309
Name:SORTER, RANDY G (MA, LPC, RMT, MR)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:G
Last Name:SORTER
Suffix:
Gender:M
Credentials:MA, LPC, RMT, MR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 WASHINGTON ST APT 309
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3743
Mailing Address - Country:US
Mailing Address - Phone:303-810-1317
Mailing Address - Fax:
Practice Address - Street 1:790 WASHINGTON ST APT 309
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3743
Practice Address - Country:US
Practice Address - Phone:303-810-1317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC-3096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional