Provider Demographics
NPI:1336275809
Name:DAWSON, RANDALL D (LPC)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:D
Last Name:DAWSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-9374
Mailing Address - Country:US
Mailing Address - Phone:913-851-3381
Mailing Address - Fax:
Practice Address - Street 1:4901 MAIN ST
Practice Address - Street 2:SUITE 310
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2646
Practice Address - Country:US
Practice Address - Phone:816-756-3505
Practice Address - Fax:816-756-3058
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002352101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional