Healthcare Provider Details

I. General information

NPI: 1689711277
Provider Name (Legal Business Name): RANDOLPH L. BROWN PSYD, MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1911 WILLIAMS DR
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 866-998-2243
  • Fax: 805-981-9268
Mailing address:
  • Phone: 866-998-2243
  • Fax: 805-981-9268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 41497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: