Provider Demographics
NPI:1518687581
Name:RANDLE, AQUANA REGINA (LMFT)
Entity Type:Individual
Prefix:
First Name:AQUANA
Middle Name:REGINA
Last Name:RANDLE
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 1:719 N FORK CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3416
Mailing Address - Country:US
Mailing Address - Phone:850-607-4737
Mailing Address - Fax:
Practice Address - Street 1:719 N FORK CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3416
Practice Address - Country:US
Practice Address - Phone:850-607-4737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4442106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist