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NPI Code Detail

MEDICARE: MR. RANDY MARSTON L.M.H.C.

MEDICARE: MR. RANDY MARSTON L.M.H.C.
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
1101YM0800XMental Health CounselorLH00003587WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MA4345OTHERWAREGENCE BLUE SHIELD

General Provider Information

NPI Number : 1578616108
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDY MARSTON L.M.H.C.
Provider Business Mailing Address
First Line : 1401 MARVIN RD NE
Second Line : 307 PMB 266
City : LACEY
State : WA
Zip : 98516-5709
Country : US
Telephone Number : 360-491-5055
Fax Number : 360-491-5890
Provider Business Practice Location Address
First Line : 677 WOODLAND SQUARE LOOP SE
Second Line :
City : LACEY
State : WA
Zip : 98503-1000
Country : US
Telephone Number : 360-352-9443
Fax Number : 360-352-8868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 07/08/2007

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