Healthcare Provider Details

I. General information

NPI: 1306521612
Provider Name (Legal Business Name): RANDY ALTON FREE LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31085 MONTESA DR
LAGUNA NIGUEL CA
92677-2721
US

IV. Provider business mailing address

31085 MONTESA DR
LAGUNA NIGUEL CA
92677-2721
US

V. Phone/Fax

Practice location:
  • Phone: 949-606-6859
  • Fax:
Mailing address:
  • Phone: 949-606-6859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92064
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: