Provider Demographics
NPI:1265075808
Name:RANDLES, KAREN RANDLES (LPCC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:RANDLES
Last Name:RANDLES
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 581855
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0031
Mailing Address - Country:US
Mailing Address - Phone:916-995-5655
Mailing Address - Fax:
Practice Address - Street 1:720 ALHAMBRA BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3825
Practice Address - Country:US
Practice Address - Phone:916-492-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty