Provider Demographics
NPI:1851975056
Name:GONZALEZ-RANDOLPH, AUSTIN (LMHC; LP)
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:
Last Name:GONZALEZ-RANDOLPH
Suffix:
Gender:M
Credentials:LMHC; LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N HOWARD ST STE R
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:425-780-5094
Mailing Address - Fax:
Practice Address - Street 1:18509 94TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3354
Practice Address - Country:US
Practice Address - Phone:414-429-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61132940101YM0800X
WAPY61278527103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health