Healthcare Provider Details

I. General information

NPI: 1154853695
Provider Name (Legal Business Name): ALLYSON RANDALL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MEDICAL ARTS AVE NE BLDG 3
ALBUQUERQUE NM
87102-2722
US

IV. Provider business mailing address

1101 MEDICAL ARTS AVE NE BLDG 3
ALBUQUERQUE NM
87102-2722
US

V. Phone/Fax

Practice location:
  • Phone: 505-933-4639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0212641
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: