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General NPI Number Information
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NPI Number | 1861863094
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Entity Type | Individual
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Provider Name | RANDY MCLAREN LPC
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Gender | Male
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 5988 MID RIVERS MALL DR STE. 113
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City | SAINT PETERS
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State | MO
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Zip | 63304-7119
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Country | US
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Telephone | 636-229-5679
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Fax |
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Provider Business Mailing Address
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Address Line | 5285 HIGHWAY N STE 103
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City | COTTLEVILLE
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State | MO
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Zip | 63304-7733
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Country | US
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Telephone | 636-357-6416
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2013036982
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License Number State | MO
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