Provider Demographics
NPI:1740451376
Name:RANDOLPH, KATHERINE M (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:M
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NIEHOFF DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-2166
Mailing Address - Country:US
Mailing Address - Phone:636-938-9192
Mailing Address - Fax:636-938-9224
Practice Address - Street 1:700 NIEHOFF DR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-2166
Practice Address - Country:US
Practice Address - Phone:636-938-9192
Practice Address - Fax:636-938-9224
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004003790101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional