Individual provider Active NPI

Lucas Randolph, LLMSW

  • Clinical Social Worker
  • South Lyon, MI
National Provider Identifier
1457083974
Registry record updated Jul 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801120440 Issued in MI
Practice address
127 N Lafayette St
South Lyon, MI 48178-1210
Phone
(248) 573-7417
NPI assigned
Jun 24, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801120440 MI Primary

Addresses

Primary practice location

127 N Lafayette St
South Lyon, MI 48178-1210

Mailing address

127 N Lafayette St
South Lyon, MI 48178-1210
Phone (248) 573-7417

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20250716003611 MI Practitioner - Clinical Social Worker 7012422199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lyon Counseling CenterGroup PAC ID 1456782564, 14 clinicians

Practice addresses (Care Compare)

127 N Lafayette St
South Lyon, MI 48178-1210
Phone (248) 573-7417

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801120440MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Lyon Counseling Center CurrentSince Jul 9, 2025 Accepting new patients
Mattioli Mental Health Clinic PLLC CurrentSince Jul 9, 2025 Accepting new patients

Locations

10524 Grand River Rd
Ste 101
Brighton, MI 48116
Phone (248) 573-7417

127 N Lafayette St
South Lyon, MI 48178
Phone (248) 573-7417

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1656028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1457083974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 N LAFAYETTE ST",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481781210",
            "telephone_number": "248-573-7417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 N LAFAYETTE ST",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481781210",
            "telephone_number": "248-573-7417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "LUCAS",
        "credential": "LLMSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-24",
        "last_updated": "2025-07-02",
        "certification_date": "2025-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801120440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Lyon, MI

Sources for this page

Verify at the official NPI Registry.