Provider Demographics
NPI:1083817662
Name:RANDI FARKAS MFT, P.C.
Entity Type:Organization
Organization Name:RANDI FARKAS MFT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:FARKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:707-578-5321
Mailing Address - Street 1:1325 BARLOW LN
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2505
Mailing Address - Country:US
Mailing Address - Phone:707-578-5321
Mailing Address - Fax:707-578-5321
Practice Address - Street 1:888 3RD ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4529
Practice Address - Country:US
Practice Address - Phone:707-578-5321
Practice Address - Fax:707-578-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-09
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28390106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty