Lori Randolph, LCSW, PEL, CYT 200

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.030335 Issued in IL

Practice address

2805 State Route 127 S
Jonesboro, IL 62952-1326

Phone

(618) 685-0580

NPI assigned

Nov 3, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mindful Pathways Family Counseling Center, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jonesboro, IL
  • NPI 1750250379
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762128000000",
    "number": "1154290757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 STATE ROUTE 127 S",
            "city": "JONESBORO",
            "state": "IL",
            "postal_code": "629521326",
            "telephone_number": "618-685-0580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 STATE ROUTE 127 S",
            "city": "JONESBORO",
            "state": "IL",
            "postal_code": "629521326",
            "telephone_number": "618-685-0580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "LORI",
        "credential": "LCSW, PEL, CYT 200",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-11-03",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.030335",
            "primary": true
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "IL",
            "license": "2546182",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hillary Meisenheimer, IBCLC
• Mindful Pathways Family Counseling Center, PLLC
• Carol Ann Palmer, MS,SLP
• Petersen Health Operations, LLC (Jonesboro Rehabilitation & Health Care Centerr)
• Petersen Health Properties, LLC (Jonesboro Rehabilitation & Health Care Center)
• Rave Residential Services, Inc (Orchard Court)
• Rave Residential Services, Inc
• Rave Residential Services, Inc. (Peachtree Estates)
• Maria Patricia Salazar
• Cassie N York

• Clinical Social Worker in Jonesboro, IL
• Providers in Jonesboro, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.