Provider Demographics
NPI:1235650714
Name:HALSTEAD, RANDAL LEE (LMFT)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:LEE
Last Name:HALSTEAD
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5104
Mailing Address - Country:US
Mailing Address - Phone:615-440-1304
Mailing Address - Fax:
Practice Address - Street 1:545 MAINSTREAM DR STE 110
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1256
Practice Address - Country:US
Practice Address - Phone:615-678-6283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1226106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist