Active NPI
Randall Martin Kahan, LCSW, LCDC, BCD
- Clinical Social Worker
- Pantego, TX
National Provider Identifier
1093794208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 00915
- Practice address
- 3337 W Pioneer Pkwy
Pantego, TX 76013-4603 - Phone
- (817) 274-0981
- Fax
- (817) 274-9712
- NPI assigned
- Jan 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 9121 | TX | |
| Clinical Social Worker | 1041C0700X | 00915 | TX | Primary |
Addresses
Primary practice location
3337 W Pioneer Pkwy
Pantego, TX 76013-4603
Mailing address
5224 Saratoga LN
Arlington, TX 76017-1863
Phone (817) 307-9178
Other practice location 1
3337 W Pioneer Pkwy
Pantego, TX 76013-4603
Phone (817) 274-0981
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 58318 | Other | AMERICAN BOARD OF EXAMINERS IN CLINICAL SOCIAL WORK BCD | |
| 071278801 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9121 | TX | MD | Addiction (Substance Use Disorder) Counselor |
| 00915 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525651200000",
"number": "1093794208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5224 SARATOGA LN",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760171863",
"telephone_number": "817-307-9178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3337 W PIONEER PKWY",
"city": "PANTEGO",
"state": "TX",
"postal_code": "760134603",
"telephone_number": "817-274-0981",
"fax_number": "817-274-9712"
}
],
"practiceLocations": [
{
"address_1": "3337 W Pioneer Pkwy",
"address_purpose": "LOCATION",
"city": "Pantego",
"state": "TX",
"postal_code": "760134603",
"country_code": "US",
"telephone_number": "817-274-0981",
"fax_number": "817-274-9712",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KAHAN",
"first_name": "RANDALL",
"middle_name": "MARTIN",
"name_prefix": "Dr.",
"credential": "LCSW, LCDC, BCD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-16",
"last_updated": "2018-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "9121",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "00915",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN BOARD OF EXAMINERS IN CLINICAL SOCIAL WORK BCD",
"identifier": "58318",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "071278801",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pantego, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.