Individual provider Active NPI

John Wesley Randall

  • Professional Counselor
  • Beaumont, TX
National Provider Identifier
1326882853
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
94078 Issued in TX
Practice address
4749 Odom Rd
Beaumont, TX 77706-7080
Phone
(409) 220-2220
NPI assigned
Jun 20, 2024
Last updated
Jun 20, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 94078 TX Primary

Addresses

Primary practice location

4749 Odom Rd
Beaumont, TX 77706-7080

Mailing address

4749 Odom Rd
Beaumont, TX 77706-7080
Phone (409) 200-2220

Other practice location 1

105 Canyon Lake Cir
Lumberton, TX 77657-3701
Phone (409) 200-2220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20251105000948 TX Practitioner - Mental Health Counselor 3577053990 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

105 Canyon Lake Cir
Lumberton, TX 77657-3701

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
94078TXMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Newpath Group Professional CurrentSince Oct 1, 2025 Accepting new patients

Locations

4749 Odom Rd
Beaumont, TX 77706
Phone (409) 200-2220

105 Canyon Lake Cir
Lumberton, TX 77657
Phone (409) 200-2220

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1718841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1326882853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4749 ODOM RD",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777067080",
            "telephone_number": "409-200-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4749 ODOM RD",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777067080",
            "telephone_number": "409-220-2220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 Canyon Lake Cir",
            "address_purpose": "LOCATION",
            "city": "Lumberton",
            "state": "TX",
            "postal_code": "776573701",
            "country_code": "US",
            "telephone_number": "409-200-2220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "JOHN",
        "middle_name": "WESLEY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-20",
        "last_updated": "2024-06-20",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "94078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

Verify at the official NPI Registry.