Individual provider Active NPI

Courtney Bliss Randolph, LPCC, LPC, LADC

  • Mental Health Counselor
  • Hudson, WI
National Provider Identifier
1740150820
Registry record updated Nov 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
4209 Issued in MN
Practice address
690 Elizabeth Way Apt 221
Hudson, WI 54016-7400
Phone
(612) 443-6166
NPI assigned
Nov 5, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 305869 MN
Mental Health Counselor 101YM0800X 11669-125 WI
Mental Health Counselor 101YM0800X 4209 MN Primary

Addresses

Primary practice location

690 Elizabeth Way Apt 221
Hudson, WI 54016-7400

Mailing address

690 Elizabeth Way Apt 221
Hudson, WI 54016-7400
Phone (612) 443-6166

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
305869MNMDAddiction (Substance Use Disorder) Counselor
4209MNMDMental Health Counselor
11669-125WIMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1762300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762300800000",
    "number": "1740150820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 ELIZABETH WAY APT 221",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167400",
            "telephone_number": "612-443-6166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 ELIZABETH WAY APT 221",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167400",
            "telephone_number": "612-443-6166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "COURTNEY",
        "middle_name": "BLISS",
        "credential": "LPCC, LPC, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-11-05",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305869",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "11669-125",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "4209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2025; 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.