Provider Demographics
NPI:1043632177
Name:RANDLES, CYNTHIA NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:NICOLE
Last Name:RANDLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N HIGGINS AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4557
Mailing Address - Country:US
Mailing Address - Phone:406-203-6937
Mailing Address - Fax:844-965-9168
Practice Address - Street 1:415 N HIGGINS AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4557
Practice Address - Country:US
Practice Address - Phone:406-203-6937
Practice Address - Fax:844-965-9168
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7134104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker