Provider Demographics
NPI:1790920197
Name:GAINFORTH, RANDALL DAVID (LMHC)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:DAVID
Last Name:GAINFORTH
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 1:5616 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-7719
Mailing Address - Country:US
Mailing Address - Phone:813-220-0262
Mailing Address - Fax:813-251-3614
Practice Address - Street 1:2111 W SWANN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2477
Practice Address - Country:US
Practice Address - Phone:813-220-0262
Practice Address - Fax:813-251-3614
Is Sole Proprietor?:No
Enumeration Date:2008-12-13
Last Update Date:2008-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health