MEDICARE: JULIANNE RANDLES

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	101YP2500X	Professional Counselor	16620	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	101YP2500X	Professional Counselor	P2412023	AR

General Provider Information

NPI Number	:	1659908721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNE RANDLES

Provider Business Mailing Address
First Line	:	PO BOX 511
Second Line	:
City	:	SCOTT
State	:	AR
Zip	:	72142-0511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4704 W COMMERCIAL DR STE A
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8040
Country	:	US
Telephone Number	:	501-819-8075
Fax Number	:

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

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	02/26/2025

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