Provider Demographics
NPI:1679858971
Name:SMITH, RANDALL EUGENE (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:EUGENE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 S DAYTON ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6184
Mailing Address - Country:US
Mailing Address - Phone:303-220-1911
Mailing Address - Fax:303-220-8107
Practice Address - Street 1:6565 S DAYTON ST STE 1500
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-6184
Practice Address - Country:US
Practice Address - Phone:303-220-1911
Practice Address - Fax:303-220-8107
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11747101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional