Lisa Randolph, MSC, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

14068 Issued in CO

Practice address

7121 Grand Prairie Dr
Colorado Springs, CO 80923-8763

Phone

(719) 229-5597

NPI assigned

Jan 15, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Lee Fennessey Other name

Medicare fee-for-service enrollment

Enrolled in CO

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

Marriage and Family Therapist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Diversus Health IncGroup PAC ID 7719879204, 49 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Diversus Health Inc

  dba Diversus Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Colorado Springs, CO
  • NPI 1043260243
  Medicare reassignment Care Compare group NPD
• Diversus Health Inc

  dba Diversus Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Colorado Springs, CO
  • NPI 1295269561
  NPD
• Diversus Health Inc

  dba Diversus Health Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Colorado Springs, CO
  • NPI 1427693902
  NPD

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

{
    "created_epoch": "1421280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591488000000",
    "number": "1336538123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7121 GRAND PRAIRIE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809238763",
            "telephone_number": "719-229-5597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7121 GRAND PRAIRIE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809238763",
            "telephone_number": "719-229-5597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "LISA",
        "credential": "MSC, MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-15",
        "last_updated": "2020-06-07",
        "certification_date": "2020-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CO",
            "license": "14068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEE",
            "last_name": "FENNESSEY",
            "credential": "MSC, MFT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Randel B. Wing Dom PC
• Meghan Randig
• Tawanna Amecca Randle, REGISTERED NURSE
• Clay Randles, PA-C
• Kathleen Mary Randolph
• Alyssa Raney
• Savannah Raney, MS, RD, LDN
• Andres Rangel
• Sergio Eduardo Rangel
• Rangewood Dental

• Marriage & Family Therapist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Marriage & Family Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2020; 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.