MEDICARE: RANDIE ABBAS

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	24072015	SD

General Provider Information

NPI Number	:	1235074329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDIE ABBAS

Provider Business Mailing Address
First Line	:	408 S ACADEMY ST
Second Line	:
City	:	LENNOX
State	:	SD
Zip	:	57039-2216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 N MAIN AVE STE 100
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-6004
Country	:	US
Telephone Number	:	605-800-7477
Fax Number	:

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

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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Directions to “ RANDIE ABBAS ” Practice Location

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