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NPI Code Detail

MEDICARE: RANDAL DEMASTERS MS, LPC

MEDICARE: RANDAL DEMASTERS MS, LPC
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
1101YM0800XMental Health Counselor1999135679MO
2101YP1600XPastoral Counselor6015VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275629925
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDAL DEMASTERS MS, LPC
Provider Business Mailing Address
First Line : 421 E 137TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64145-1455
Country : US
Telephone Number : 816-508-3638
Fax Number :
Provider Business Practice Location Address
First Line : 421 E 137TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64145-1455
Country : US
Telephone Number : 816-508-3638
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 03/26/2009

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