Provider Demographics
NPI:1588836027
Name:CHATELAIN, RANDY SCOTT (PHD MFT)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:SCOTT
Last Name:CHATELAIN
Suffix:
Gender:M
Credentials:PHD MFT
Other - Prefix:DR
Other - First Name:RANDY
Other - Middle Name:S
Other - Last Name:CHATELAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD MFT
Mailing Address - Street 1:3500 HARRISON BLVD
Mailing Address - Street 2:#105
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2038
Mailing Address - Country:US
Mailing Address - Phone:801-393-7331
Mailing Address - Fax:
Practice Address - Street 1:3500 HARRISON BLVD
Practice Address - Street 2:#105
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2038
Practice Address - Country:US
Practice Address - Phone:801-393-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT831147003902MFT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist