Provider Demographics
NPI:1861863094
Name:MCLAREN, RANDY (LPC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:MCLAREN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5285 HIGHWAY N STE 103
Mailing Address - Street 2:
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7733
Mailing Address - Country:US
Mailing Address - Phone:636-357-6416
Mailing Address - Fax:
Practice Address - Street 1:5988 MID RIVERS MALL DR
Practice Address - Street 2:STE. 113
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63304-7119
Practice Address - Country:US
Practice Address - Phone:636-229-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013036982101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1861032799Medicaid