Provider Demographics
NPI:1811135783
Name:RHEINHEIMER, RANDALL CRAIG (PHD, MFT)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:CRAIG
Last Name:RHEINHEIMER
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17852 17TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2100
Mailing Address - Country:US
Mailing Address - Phone:714-573-0000
Mailing Address - Fax:
Practice Address - Street 1:17852 17TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2100
Practice Address - Country:US
Practice Address - Phone:714-573-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 22685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist