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General NPI Number Information
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NPI Number | 1194569293
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Entity Type | Individual
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Provider Name | RANDOLPH FARASE
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Gender | Male
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Dates
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Enumeration Date | 06/24/2024
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 1382 BLUE OAKS BLVD STE 213
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City | ROSEVILLE
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State | CA
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Zip | 95678-7052
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Country | US
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Telephone | 916-312-4669
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Fax |
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Provider Business Mailing Address
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Address Line | 2335 AMERICAN RIVER DR STE 301
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City | SACRAMENTO
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State | CA
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Zip | 95825-7088
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Country | US
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Telephone | 916-609-5100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT143296
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License Number State | CA
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