Provider Demographics
NPI:1871684456
Name:SINCLAIR, RANDALL LEWIS (MFT)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:LEWIS
Last Name:SINCLAIR
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 1:16519 VICTOR ST
Mailing Address - Street 2:406
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3965
Mailing Address - Country:US
Mailing Address - Phone:760-843-0506
Mailing Address - Fax:760-843-0507
Practice Address - Street 1:16519 VICTOR ST
Practice Address - Street 2:406
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3965
Practice Address - Country:US
Practice Address - Phone:760-843-0506
Practice Address - Fax:760-843-0507
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33232106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist