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General NPI Number Information
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NPI Number | 1508135625
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Entity Type | Individual
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Provider Name | RANDALL ALAN ANDERSON LPE-I
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Gender | Male
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 110 SKYLINE DR
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-3362
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Country | US
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Telephone | 479-968-1298
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Fax | 479-968-6053
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Provider Business Mailing Address
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Address Line | 2400 S 48TH ST
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City | SPRINGDALE
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State | AR
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Zip | 72762-6683
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Country | US
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Telephone | 479-750-2020
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Fax | 479-750-4843
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 88-12EI
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 88-12EI
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License Number State | AR
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