Healthcare Provider Details

I. General information

NPI: 1235650714
Provider Name (Legal Business Name): RANDAL LEE HALSTEAD LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 HILLSBORO PIKE STE 320
NASHVILLE TN
37215-3332
US

IV. Provider business mailing address

5016 BRIARWOOD DR
NASHVILLE TN
37211-5104
US

V. Phone/Fax

Practice location:
  • Phone: 615-440-1304
  • Fax:
Mailing address:
  • Phone: 615-440-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1226
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: