Provider Demographics
NPI:1770183246
Name:RANDALL, NIKKI SURINDER (MFTC)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:SURINDER
Last Name:RANDALL
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7159 E 123RD PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8043
Mailing Address - Country:US
Mailing Address - Phone:630-901-2948
Mailing Address - Fax:
Practice Address - Street 1:7921 SOUTHPARK PLZ STE 204
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4506
Practice Address - Country:US
Practice Address - Phone:720-489-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist