Provider Demographics
NPI:1982638219
Name:CLASS, RANDY (LSCSW)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:CLASS
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N BROADWAY ST
Mailing Address - Street 2:STE. 600
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2324
Mailing Address - Country:US
Mailing Address - Phone:316-858-1200
Mailing Address - Fax:316-858-1204
Practice Address - Street 1:200 N BROADWAY ST
Practice Address - Street 2:STE. 600
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2324
Practice Address - Country:US
Practice Address - Phone:316-858-1200
Practice Address - Fax:316-858-1204
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical