Look up the most recent NPI and PECOS records

Randolph G. Russ

Counselor

Behavioral Health & Social Service Providers

8461 Lake Worth Rd, Suite 120, Lake Worth, FL 33467-2474

PECOS Enrollment

Based on the most recent information from CMS, provider Randolph G. Russ does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1548625007
Provider Type
Organization
Full Name
Randolph G. Russ

Subpart
No
Enumeration Date
12/28/2015
Last Updated
8/2/2021

Contact Information

Practice Location

8461 Lake Worth Rd, Suite 120, Lake Worth, FL 33467-2474

(561) 201-7180

Unlisted Fax

Mailing Location

8461 Lake Worth Rd, Suite 120, Lake Worth, FL 33467

(561) 201-7180

(561) 839-1802

Authorized Official

Russ, Randolph Graham (President)

(561) 201-7180

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer
Code 103K00000X	Description Behavior Analyst Behavioral Health & Social Service Providers	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 000094200	Description Medicaid	Issuer Unlisted Florida
ID 102043700	Description Medicaid	Issuer Unlisted Florida

Randolph G. Russ

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Reyes-Hernandez, Lucia

Wolfe, Taylor Shannon

Potter, Rebecca June

Murtha, Caitlyn Lilly

Scala, Taryn

Smith, Jeremiah Cody

Ruiz, Elizabeth

Debra Blizzard Lmhc Pllc

Cooper, Ashley Celia

Brazelton, Jodie Lynn