Active NPI
Randolph G. Russ
- Mental Health Counselor
- Lake Worth, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Legal business name
- RANDOLPH G. RUSS
- Practice address
- 8461 Lake Worth Rd
Suite 120
Lake Worth, FL 33467-2474 - Phone
- (561) 201-7180
- NPI assigned
- Dec 28, 2015
- Last updated
- Aug 2, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Randolph Graham Russ
- Title
- President
- Phone
- (561) 201-7180
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary | ||
| Behavior Analyst | 103K00000X |
Addresses
Primary practice location
8461 Lake Worth Rd
Suite 120
Lake Worth, FL 33467-2474
Mailing address
8461 Lake Worth Rd
Suite 120
Lake Worth, FL 33467
Phone (561) 201-7180
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000094200 | Medicaid | FL | |
| 102043700 | Medicaid | FL |
National Provider Directory
National Provider DirectoryLocations
8461 Lake Worth Rd
Ste 120
Lake Worth, FL 33467
Phone (561) 201-7180
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Mental Health Counselor
- Wellington, FL
- NPI 1437326873
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451260800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1627862400000",
"number": "1548625007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8461 LAKE WORTH RD",
"address_2": "SUITE 120",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "33467",
"telephone_number": "561-201-7180",
"fax_number": "561-839-1802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8461 LAKE WORTH RD",
"address_2": "SUITE 120",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334672474",
"telephone_number": "561-201-7180"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RANDOLPH G. RUSS",
"organizational_subpart": "NO",
"enumeration_date": "2015-12-28",
"last_updated": "2021-08-02",
"certification_date": "2021-08-02",
"status": "A",
"authorized_official_last_name": "RUSS",
"authorized_official_first_name": "RANDOLPH",
"authorized_official_middle_name": "GRAHAM",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "561-201-7180",
"authorized_official_name_prefix": "Dr."
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "103K00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000094200",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102043700",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Worth, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.