=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174249957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RANDALYN BARROW LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2022
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1309 BENNETT AVE
-----------------------------------------------------
City | BURLEY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83318-2676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-725-3145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 794 EASTLAND DR
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301-6856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-734-3312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LMSW-42711
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 8911152
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------