Provider Demographics
NPI:1174882492
Name:RANDOLPH, STEPHANIE (MA, PLPC, NCC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:MA, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3703
Mailing Address - Country:US
Mailing Address - Phone:816-505-4864
Mailing Address - Fax:816-455-3711
Practice Address - Street 1:2001 NE PARVIN RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-2446
Practice Address - Country:US
Practice Address - Phone:816-505-4864
Practice Address - Fax:816-455-3711
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012010107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional