Provider Demographics
NPI:1730251364
Name:STILES, RANDALL JAMES (PHD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JAMES
Last Name:STILES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 APRIL MIST ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-8681
Mailing Address - Country:US
Mailing Address - Phone:702-565-1496
Mailing Address - Fax:
Practice Address - Street 1:522 E LAKE MEAD PKWY STE 5
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5573
Practice Address - Country:US
Practice Address - Phone:702-486-6722
Practice Address - Fax:702-486-6741
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0307103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent