Provider Demographics
NPI:1134391550
Name:RANDALL, NYSHAUNTE MARYA (LPC-S)
Entity type:Individual
Prefix:MRS
First Name:NYSHAUNTE
Middle Name:MARYA
Last Name:RANDALL
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:NYSHAUNTE
Other - Middle Name:M
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2127 MESA VIA
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2950
Mailing Address - Country:US
Mailing Address - Phone:504-235-1233
Mailing Address - Fax:
Practice Address - Street 1:2127 MESA VIA
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2950
Practice Address - Country:US
Practice Address - Phone:504-235-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
LA3890101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional