Provider Demographics
NPI:1598459133
Name:WHITSITT, RANDALL DRAY
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:DRAY
Last Name:WHITSITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 N MOUNT CARMEL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-1750
Mailing Address - Country:US
Mailing Address - Phone:316-650-8199
Mailing Address - Fax:
Practice Address - Street 1:1601 W 16TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-8125
Practice Address - Country:US
Practice Address - Phone:620-326-7448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health