Provider Demographics
NPI:1811026263
Name:MEY, RANDALL ROBERT (LMSW)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:ROBERT
Last Name:MEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5983
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-0983
Mailing Address - Country:US
Mailing Address - Phone:989-399-9233
Mailing Address - Fax:989-399-9234
Practice Address - Street 1:1711 COURT ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4072
Practice Address - Country:US
Practice Address - Phone:989-399-9233
Practice Address - Fax:989-399-9234
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010719781041C0700X
MI4101006152106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP06270001Medicare ID - Type UnspecifiedMEMBER #