Provider Demographics
NPI:1891086336
Name:MASTERSON, RANDY ERWIN (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:ERWIN
Last Name:MASTERSON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:SARANAC
Mailing Address - State:MI
Mailing Address - Zip Code:48881-9533
Mailing Address - Country:US
Mailing Address - Phone:616-550-6498
Mailing Address - Fax:
Practice Address - Street 1:13 N BRIDGE ST STE A
Practice Address - Street 2:
Practice Address - City:SARANAC
Practice Address - State:MI
Practice Address - Zip Code:48881-5122
Practice Address - Country:US
Practice Address - Phone:616-552-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002718101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor