Provider Demographics
NPI:1659558500
Name:RANDALL-MESSENGER, JULIANNE BETH (LLMSW)
Entity Type:Individual
Prefix:MISS
First Name:JULIANNE
Middle Name:BETH
Last Name:RANDALL-MESSENGER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:BETH
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLMSW
Mailing Address - Street 1:56158 STONEY PLACE LN
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4917
Mailing Address - Country:US
Mailing Address - Phone:517-282-5427
Mailing Address - Fax:
Practice Address - Street 1:38800 GARFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6619
Practice Address - Country:US
Practice Address - Phone:586-231-0306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
MI68511148221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6851114822Medicaid