Provider Demographics
NPI:1023457215
Name:RANDOLPH, ELON
Entity type:Individual
Prefix:
First Name:ELON
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SELMI DR STE 601
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-4794
Mailing Address - Country:US
Mailing Address - Phone:775-420-5396
Mailing Address - Fax:775-420-5053
Practice Address - Street 1:1130 SELMI DR STE 601
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-4794
Practice Address - Country:US
Practice Address - Phone:775-420-5396
Practice Address - Fax:775-420-5053
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst