Provider Demographics
NPI:1437957081
Name:CUNNINGHAM, RANDI MICHELLE
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:MICHELLE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14650 COUNTY ROAD 20
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-6508
Mailing Address - Country:US
Mailing Address - Phone:806-202-7073
Mailing Address - Fax:
Practice Address - Street 1:215 S KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-2453
Practice Address - Country:US
Practice Address - Phone:806-202-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96951101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor