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Provider Information for 1215538772


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Ms. JANITA RANDOLPH LMFT


Sex: Female

NPI: 1215538772
Last Updated: 2020-11-02
Certification Date: 2020-11-02

Details

NameValue
NPI1215538772
Enumeration Date2020-11-02
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 2325 ENZIE DR APT 2
LAS CRUCES, NM 88001-5880
United States

Phone: 915-740-3494 | Fax:
 
Primary Practice Address 2325 ENZIE DR APT 2
LAS CRUCES, NM 88001-5880
United States

Phone: 915-740-3494 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 106H00000X - Marriage & Family Therapist NMCMF0213941