MEDICARE: DR. RANDALL MARTIN KAHAN LCSW, LCDC, BCD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	9121	TX
2	1041C0700X	Clinical Social Worker	00915	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	58318	OTHER		AMERICAN BOARD OF EXAMINERS IN CLINICAL SOCIAL WORK BCD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093794208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL MARTIN KAHAN LCSW, LCDC, BCD

Provider Business Mailing Address
First Line	:	5224 SARATOGA LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1863
Country	:	US
Telephone Number	:	817-307-9178
Fax Number	:

Provider Business Practice Location Address
First Line	:	3337 W PIONEER PKWY
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-4603
Country	:	US
Telephone Number	:	817-274-0981
Fax Number	:	817-274-9712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	05/07/2018

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Directions to “ DR. RANDALL MARTIN KAHAN LCSW, LCDC, BCD” Practice Location

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