Provider Demographics
NPI:1629534631
Name:MCNEILL, RANDI MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:MICHELLE
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:MICHELLE
Other - Last Name:THORNBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:369 INVERNESS PKWY STE 375
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6083
Mailing Address - Country:US
Mailing Address - Phone:303-284-7328
Mailing Address - Fax:
Practice Address - Street 1:369 INVERNESS PKWY STE 375
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-284-7328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program