Provider Demographics
NPI:1659493385
Name:HARPER, RANDALL WAYNE (PHD, MED, BSED)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:WAYNE
Last Name:HARPER
Suffix:
Gender:M
Credentials:PHD, MED, BSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 HEMLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-5952
Mailing Address - Country:US
Mailing Address - Phone:208-305-6551
Mailing Address - Fax:
Practice Address - Street 1:2841 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4719
Practice Address - Country:US
Practice Address - Phone:208-305-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor