Provider Demographics
NPI:1689722902
Name:RAND, KEITH J (MFT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:J
Last Name:RAND
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 BEVERLY BLVD
Mailing Address - Street 2:STE. 204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4524
Mailing Address - Country:US
Mailing Address - Phone:323-655-4060
Mailing Address - Fax:
Practice Address - Street 1:8170 BEVERLY BLVD
Practice Address - Street 2:STE. 204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4524
Practice Address - Country:US
Practice Address - Phone:323-655-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 32393106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist