1275884330 NPI number — MR. RANDALL SEAN ROLLINSON LPC

Table of content: MR. RANDALL SEAN ROLLINSON LPC (NPI 1275884330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275884330 NPI number — MR. RANDALL SEAN ROLLINSON LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROLLINSON
Provider First Name:
RANDALL
Provider Middle Name:
SEAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROLLINSON
Provider Other First Name:
R.
Provider Other Middle Name:
SEAN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275884330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 E EARLL DR
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85012-2634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-819-2657
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 E EARLL DR
Provider Second Line Business Practice Location Address:
STE. 160
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85012-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-471-8560
Provider Business Practice Location Address Fax Number:
888-979-8197
Provider Enumeration Date:
09/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC-15949 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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