Provider Demographics
NPI:1679832042
Name:MCCLINTOCK, RANDAL JACKSON
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:JACKSON
Last Name:MCCLINTOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RANDAL
Other - Middle Name:LOUIS
Other - Last Name:SALINAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1481 W WARM SPRINGS RD STE 129
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-7636
Mailing Address - Country:US
Mailing Address - Phone:702-547-0201
Mailing Address - Fax:702-944-7846
Practice Address - Street 1:1481 W WARM SPRINGS RD STE 129
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7636
Practice Address - Country:US
Practice Address - Phone:702-547-0201
Practice Address - Fax:702-944-7846
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor