Provider Demographics
NPI:1558065771
Name:RANDOLPH, LATOYA N (MFT)
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:N
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 BEACONSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-8157
Mailing Address - Country:US
Mailing Address - Phone:813-404-2678
Mailing Address - Fax:
Practice Address - Street 1:10320 N 56TH ST STE 220
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-4057
Practice Address - Country:US
Practice Address - Phone:813-404-2678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist