Provider Demographics
NPI:1780449132
Name:RANDY S KIRKSEY MARRIAGE AND FAMILY THERAPIST
Entity type:Organization
Organization Name:RANDY S KIRKSEY MARRIAGE AND FAMILY THERAPIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:228-990-3701
Mailing Address - Street 1:912 CONVENT AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-4334
Mailing Address - Country:US
Mailing Address - Phone:228-990-3701
Mailing Address - Fax:
Practice Address - Street 1:912 CONVENT AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-4334
Practice Address - Country:US
Practice Address - Phone:228-990-3701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty