Randell Allen Kohberger

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

7465 W Lake Mead Blvd Ste 103
Las Vegas, NV 89128-1032

Phone

(702) 562-1293

NPI assigned

Mar 19, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Change Is Real Behavioral Health Services

  • Community/Behavioral Health Agency
  • Las Vegas, NV
  • NPI 1437789823
  NPD

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

{
    "created_epoch": "1647648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647648000000",
    "number": "1619626587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 E WINDMILL LN STE 1C",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891231870",
            "telephone_number": "702-798-3356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7465 W LAKE MEAD BLVD STE 103",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281032",
            "telephone_number": "702-562-1293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOHBERGER",
        "first_name": "RANDELL",
        "middle_name": "ALLEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-19",
        "last_updated": "2022-03-19",
        "certification_date": "2022-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Ann Kogut, M.D., P.C.
• Chee Hiong Koh, NP-C
• Stephanie Sun Koh, FNP-C
• Benny Kohanteb, DDS
• Jessica Rene' Kohara, RN
• Sina Kohistani
• Catherine Kohl, RN
• Rachel A Kohl, OMD
• Jeffery Kohler
• Lisa Kohley

• Mental Health Counselor in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Mental Health Counselor in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.