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General NPI Number Information
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NPI Number | 1235945429
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Entity Type | Individual
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Provider Name | DAYSHA JA'NAE RANDLE PLPC/PLMFT
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Gender | Female
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 2913 DESIARD ST
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City | MONROE
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State | LA
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Zip | 71201-7207
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Country | US
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Telephone | 318-388-1250
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Fax |
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Provider Business Mailing Address
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Address Line | 228 LENOX BRG
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City | STERLINGTON
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State | LA
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Zip | 71280-3346
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Country | US
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Telephone | 318-542-0918
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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 | PLM1544
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | PLC10167
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License Number State | LA
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