Basic Information
| Provider Information | |||||||||
| NPI: | 1871902288 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRAH | ||||||||
| FirstName: | RANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17606 COSHOCTON RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430509218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403970533 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17606 COSHOCTON RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430509218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403970533 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2014 | ||||||||
| LastUpdateDate: | 08/11/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | S1450673 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.