Provider Demographics
NPI:1417180217
Name:RINDOM, ROY (LMHC)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:RINDOM
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE # 409
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6615
Mailing Address - Country:US
Mailing Address - Phone:954-696-9750
Mailing Address - Fax:
Practice Address - Street 1:2500 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE # 409
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6615
Practice Address - Country:US
Practice Address - Phone:954-696-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8804101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor