MEDICARE: KIZZY RANDLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033697321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIZZY RANDLE

Provider Business Mailing Address
First Line	:	2836 JOSEPHINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70113-2914
Country	:	US
Telephone Number	:	504-858-1887
Fax Number	:

Provider Business Practice Location Address
First Line	:	2836 JOSEPHINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70113-2914
Country	:	US
Telephone Number	:	504-858-1887
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	07/30/2018

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Directions to “ KIZZY RANDLE ” Practice Location

Language	Start Address	Practice Location

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