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General NPI Number Information
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NPI Number | 1700054624
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Entity Type | Individual
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Provider Name | JILL RANDALL LPC
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Gender | Female
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 800 KALISTE SALOOM RD
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City | LAFAYETTE
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State | LA
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Zip | 70508-4210
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Country | US
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Telephone | 337-718-7737
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Fax | 337-205-8669
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Provider Business Mailing Address
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Address Line | 109 WATERBERRY DR
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City | BROUSSARD
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State | LA
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Zip | 70518-9104
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Country | US
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Telephone | 337-837-1126
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Fax | 337-205-8669
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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