MS. THEODORA LUGENE RANDOLPH (NPI# 1245570027) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245570027 |
| Entity Type | Individual |
| Full Name | MS. THEODORA LUGENE RANDOLPH |
| Practice Address |
6007 Crumbling Ridge St Henderson NV 89011-1898 |
| Mailing Address |
6007 Crumbling Ridge St Henderson NV 89011-1614 |
| Practice Telephone | 7025449454 |
| Mailing Telephone | 7025449454 |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2016-10-20 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
Behavioral Health & Social Service Providers | ||
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers |
| Street Address |
6007 CRUMBLING RIDGE ST |
| City | HENDERSON |
| State | NV |
| Zip Code | 89011-1898 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891322749 | Lauren Chapple Love | Student in an Organized Health Care Education/Training Program | 1820 E. Warm Springs Rd, Suite 115, Suite 115, Henderson, NV 89011 | 2020-03-23 |
| 1972139780 | Fresenius Medical Care Nkdhc, LLC | Clinic/Center | 1051 Wellness Pl, Suite 100, Henderson, NV 89011 | 2020-03-13 |
| 1720508658 | Dennis Cortez | Nurse Practitioner | 800 N. Gibson Rd., 201, Henderson, NV 89011 | 2017-06-21 |
| 1003281452 | Henderson Hospital | General Acute Care Hospital | 1050 West Galleria Drive, Henderson, NV 89011 | 2015-12-10 |
| 1962821645 | Champions Behavioral Health Care | Counselor | 833 Aspen Peak Loop #524, Henderson, NV 89011 | 2014-04-10 |
| 1154748127 | Mission Treatment Centers, Inc. | Community/Behavioral Health | 1536 N. Boulder Highway, Henderson, NV 89011 | 2014-03-27 |
| 1174951651 | Neveda Behavioral Health | Behavioral Analyst | 930 Canale Drive, Henderson, NV 89011 | 2013-10-21 |
| 1720358039 | Dignity Health | Neurological Surgery | 800 N Gibson Rd Ste 101, Henderson, NV 89011 | 2012-01-03 |
| 1003102682 | Kerri S. Korin | Social Worker | 3155 E. Patrick Lane, Suite 1, Las Vegas, NV 89011 | 2011-06-22 |
| 1306163993 | Recovercare LLC | Durable Medical Equipment & Medical Supplies | 513 West Sunset Rd, Henderson, NV 89011 | 2010-04-22 |
| Find all providers in zip 89011 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962002964 | Andrew Justin Freeman | Psychologist | 1485 W Warm Springs Rd Ste 109, Henderson, NV 89014-7632 | 2020-10-28 |
| 1730523572 | Samantha Christine Flores | Psychologist | 1651 American Pacific Dr, Unit#2303, Henderson, NV 89074-7601 | 2013-04-23 |
| 1730251364 | Randall James Stiles | Psychologist | 522 E Lake Mead Pkwy Ste 5, Henderson, NV 89015-5573 | 2006-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104437946 | Coates & Doran, Pllc | Psychologist | 1812 Marian Ave, Carson City, NV 89706-2632 | 2020-08-14 |
| 1316495583 | Each Child An Achiever Corporation | Psychologist | 1225 E Hacienda Ave, #2, Las Vegas, NV 89119-5027 | 2016-09-16 |
| 1730505553 | Alexis Manning-espinda | Psychologist | 1550 Lorilyn Ave Unit 2, Las Vegas, NV 89119-7662 | 2014-03-17 |
| 1588087860 | Tonya Cooper | Psychologist | 2701 N Decatur Blvd Apt 1055, Las Vegas, NV 89108-2969 | 2014-01-22 |
| 1609298256 | Cynthia Bolden | Psychologist | 1957 Susan St, Las Vegas, NV 89106-2654 | 2014-01-16 |
| 1700217031 | Adrian Brown | Psychologist | 5824 W Oakey Blvd, Las Vegas, NV 89146-1243 | 2013-12-12 |
| 1639501935 | Debora Cole | Psychologist | 2504 Clayton St, North Las Vegas, NV 89032-3802 | 2013-08-08 |
| 1275871238 | Porscha Menyweather | Psychologist | 4316 E Tropicana Ave, Las Vegas, NV 89121-6704 | 2013-01-26 |
| 1689918054 | Tangy Denise Goffner | Psychologist | 1129 W Monroe Ave, Las Vegas, NV 89106-2914 | 2012-11-24 |
| 1710246921 | Life Gateway | Psychologist | 2128 Pink Coral Dr, North Las Vegas, NV 89031-0985 | 2012-05-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.