Healthcare Provider Details

I. General information

NPI: 1235945429
Provider Name (Legal Business Name): DAYSHA JA'NAE RANDLE PLPC/PLMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 DESIARD ST
MONROE LA
71201-7207
US

IV. Provider business mailing address

228 LENOX BRG
STERLINGTON LA
71280-3346
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-1250
  • Fax:
Mailing address:
  • Phone: 318-542-0918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC10167
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberPLM1544
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: