Provider Demographics
NPI:1588184048
Name:STUTHARD, RANDI L
Entity Type:Individual
Prefix:MS
First Name:RANDI
Middle Name:L
Last Name:STUTHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3725
Mailing Address - Country:US
Mailing Address - Phone:231-578-2977
Mailing Address - Fax:
Practice Address - Street 1:1475 ROBBINS RD STE 210
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2799
Practice Address - Country:US
Practice Address - Phone:616-844-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional