MEDICARE: RANDALL PATEE LCSW

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	39000350A	IN
2	1041C0700X	Clinical Social Worker	34002367	IN
3	106H00000X	Marriage & Family Therapist	35000024	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1386754018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL PATEE LCSW

Provider Business Mailing Address
First Line	:	105 S GOOD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 N POST ROAD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-8581
Country	:	US
Telephone Number	:	317-282-3088
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/26/2023

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