Active NPI
Marque E Randall, PHD
- Counseling Psychologist
- Logan, UT
National Provider Identifier
1457371189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 52285242501
- Practice address
- 1300 N 200 E
Ste 114-a
Logan, UT 84341-2398 - Phone
- (435) 753-2687
- NPI assigned
- Jul 19, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 52285242501 | UT | Primary |
Addresses
Primary practice location
1300 N 200 E
Ste 114-a
Logan, UT 84341-2398
Mailing address
1300 N 200 E
Ste 114-a
Logan, UT 84341-2398
Phone (435) 753-2687
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 85006 | Other | UT | PEHP |
| 107019240103 | Other | UT | IHC |
| 885077 | Other | UT | DMBA |
| 52285242501001 | Other | UT | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2022 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52285242501 | UT | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| LDS Family Services | Past | Accepting new patients |
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 and National Provider Directory roles.
-
dba LDS Family Services UT Logan Agency
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Logan, UT
- NPI 1801994132
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188518400000",
"number": "1457371189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 N 200 E",
"address_2": "STE 114-A",
"city": "LOGAN",
"state": "UT",
"postal_code": "843412398",
"telephone_number": "435-753-2687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 N 200 E",
"address_2": "STE 114-A",
"city": "LOGAN",
"state": "UT",
"postal_code": "843412398",
"telephone_number": "435-753-2687"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "MARQUE",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2007-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "UT",
"license": "52285242501",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEHP",
"identifier": "85006",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHC",
"identifier": "107019240103",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMBA",
"identifier": "885077",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "52285242501001",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.