Provider Demographics
NPI:1700284270
Name:ALLEN, RANDALL
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 N RIDGE LOOP DR
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7243
Mailing Address - Country:US
Mailing Address - Phone:575-956-6390
Mailing Address - Fax:575-956-6074
Practice Address - Street 1:3201 N RIDGE LOOP DR
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7243
Practice Address - Country:US
Practice Address - Phone:575-956-6390
Practice Address - Fax:575-956-6074
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-19906101YM0800X
NMCTB-2025-0275101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health