MEDICARE: ELIZABETH RANDALL LMHC

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	61563951	WA
2	101YM0800X	Mental Health Counselor	LH61563951	WA

General Provider Information

NPI Number	:	1124530902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH RANDALL LMHC

Provider Business Mailing Address
First Line	:	3034 SW CHARLESTOWN ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-2525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3034 SW CHARLESTOWN ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-2525
Country	:	US
Telephone Number	:	206-312-4884
Fax Number	:	206-460-0696

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

Provider Enumeration Date	:	11/01/2017
Last Update Date	:	12/26/2024

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