Provider Demographics
NPI:1144671579
Name:HALCON, RANDI (LMFT)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:HALCON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93016-0583
Mailing Address - Country:US
Mailing Address - Phone:805-276-7047
Mailing Address - Fax:
Practice Address - Street 1:1133 SHADY LN
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1038
Practice Address - Country:US
Practice Address - Phone:805-276-7047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist