Active NPI
King Richard Randell, LPC, CADAC, ICADC
- Professional Counselor
- Benson, AZ
National Provider Identifier
1790095313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-1244
- Practice address
- 590 S Ocotillo Ave
Benson, AZ 85602-6405 - Phone
- (520) 586-7080
- Fax
- (520) 586-6104
- NPI assigned
- Oct 15, 2010
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CADAC-1607 | AZ | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | ICADC-122108 | AZ | |
| Professional Counselor | 101YP2500X | LPC-1244 | AZ | Primary |
Addresses
Primary practice location
590 S Ocotillo Ave
Benson, AZ 85602-6405
Mailing address
611 W Union St
Benson, AZ 85602-6718
Phone (520) 586-0800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CADAC-1607 | AZ | MD | Addiction (Substance Use Disorder) Counselor |
| ICADC-122108 | AZ | MD | Addiction (Substance Use Disorder) Counselor |
| LPC-1244 | AZ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287100800000",
"number": "1790095313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 W UNION ST",
"city": "BENSON",
"state": "AZ",
"postal_code": "856026718",
"telephone_number": "520-586-0800",
"fax_number": "520-586-0116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "590 S OCOTILLO AVE",
"city": "BENSON",
"state": "AZ",
"postal_code": "856026405",
"telephone_number": "520-586-7080",
"fax_number": "520-586-6104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDELL",
"first_name": "KING",
"middle_name": "RICHARD",
"name_prefix": "Mr.",
"credential": "LPC, CADAC, ICADC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-10-15",
"last_updated": "2010-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "AZ",
"license": "CADAC-1607",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "AZ",
"license": "ICADC-122108",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AZ",
"license": "LPC-1244",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.