Basic Information
| Provider Information | |||||||||
| NPI: | 1215192539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEYL | ||||||||
| FirstName: | RANDI | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | LSW | ||||||||
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| OtherLastName: | LEE | ||||||||
| OtherFirstName: | RANDI | ||||||||
| OtherMiddleName: | JEAN | ||||||||
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| OtherCredential: | LMFT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1900 SILVER LAKE RD NW | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | NEW BRIGHTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551121786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516289566 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7300 147TH STREET | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | APPLE VALLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529973020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2008 | ||||||||
| LastUpdateDate: | 04/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 18550 | MN | N | Behavioral Health & Social Service Providers | Social Worker | 106H00000X | 3011 | MN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.