Provider Demographics
NPI:1265587141
Name:RANDALL, JUDITH A (LMFT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:RANDALL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14291 W. 91ST LANE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005
Mailing Address - Country:US
Mailing Address - Phone:858-776-4815
Mailing Address - Fax:
Practice Address - Street 1:8771 WOLF CT.
Practice Address - Street 2:#210
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031
Practice Address - Country:US
Practice Address - Phone:858-776-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA44323106H00000X
CO953106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21587507Medicaid