Active NPI
Randell Wilson, LCSW, LSCSW
- Clinical Social Worker
- Houston, TX
National Provider Identifier
1730260290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 58189
- Practice address
- 16602 Cold Harbor LN
Houston, TX 77083-7204 - Phone
- (913) 206-1554
- NPI assigned
- Oct 18, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2001027963 | MO | |
| Clinical Social Worker | 1041C0700X | 2204 | KS | |
| Clinical Social Worker | 1041C0700X | 58189 | TX | Primary |
Addresses
Primary practice location
16602 Cold Harbor LN
Houston, TX 77083-7204
Mailing address
16602 Cold Harbor LN
Houston, TX 77083-7204
Phone (913) 206-1554
Other practice location 1
1534 Campbell St
Kansas City, MO 64108-1520
Phone (816) 421-6670 ext. 1202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kansas City Community Center | Past | Accepting new patients | |
| Heartland Center for Behavioral Change | Past | Accepting new patients |
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.
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Kansas City, MO
- NPI 1053587469
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Kansas City, MO
- NPI 1881838134
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655078400000",
"number": "1730260290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16602 COLD HARBOR LN",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770837204",
"telephone_number": "913-206-1554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16602 COLD HARBOR LN",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770837204",
"telephone_number": "913-206-1554"
}
],
"practiceLocations": [
{
"address_1": "1534 Campbell St",
"address_purpose": "LOCATION",
"city": "Kansas City",
"state": "MO",
"postal_code": "641081520",
"country_code": "US",
"telephone_number": "816-421-6670 x1202",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "RANDELL",
"credential": "LCSW, LSCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2022-06-13",
"certification_date": "2022-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "2001027963",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KS",
"license": "2204",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "58189",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.