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General NPI Number Information
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NPI Number | 1063221588
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Entity Type | Organization
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Legal Business Name | RANDY L ERVIN LLC
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 727 N LINCOLN AVE STE 1
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City | YORK
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State | NE
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Zip | 68467-2948
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Country | US
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Telephone | 316-230-7900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 473
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City | YORK
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State | NE
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Zip | 68467-0473
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Country | US
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Telephone | 316-230-7900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDY LEE ERVIN
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Credential | PSY.D.
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Telephone | 316-230-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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