Provider Demographics
NPI:1922864107
Name:BECKER, RANDI LAUREN (ATR-BC, LCMHC)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:LAUREN
Last Name:BECKER
Suffix:
Gender:F
Credentials:ATR-BC, LCMHC
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:
Other - Last Name:BISHINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATR-BC
Mailing Address - Street 1:5133 ST GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7671
Mailing Address - Country:US
Mailing Address - Phone:305-609-6200
Mailing Address - Fax:
Practice Address - Street 1:5133 ST GEORGE RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7671
Practice Address - Country:US
Practice Address - Phone:305-609-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health