Provider Demographics
NPI:1659550879
Name:RANDALL RAY MASTERSON
Entity Type:Organization
Organization Name:RANDALL RAY MASTERSON
Other - Org Name:ASSOCIATED PSYCHOLOGISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSCSP
Authorized Official - Phone:618-392-2725
Mailing Address - Street 1:302 S KITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-1500
Mailing Address - Country:US
Mailing Address - Phone:618-392-2725
Mailing Address - Fax:
Practice Address - Street 1:302 S KITCHELL AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-1500
Practice Address - Country:US
Practice Address - Phone:618-392-2725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006994103TC0700X
IL969847103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty