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General NPI Number Information
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NPI Number | 1922152586
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Entity Type | Individual
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Provider Name | RANDALL EUGENE CLECKLER LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 300 GAULT AVE S
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City | FORT PAYNE
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State | AL
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Zip | 35968
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Country | US
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Telephone | 256-997-9356
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Fax | 256-997-9314
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Provider Business Mailing Address
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Address Line | 300 GAULT AVE S
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City | FORT PAYNE
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State | AL
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Zip | 35968
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Country | US
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Telephone | 256-997-9356
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Fax | 256-997-9314
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 1167C
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 1167C
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License Number State | AL
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