Provider Demographics
NPI:1114011384
Name:HALBERDA, RANDY (PSYD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:HALBERDA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:RANDALL
Other - Middle Name:
Other - Last Name:HALBERDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:5500 ARMSTRONG RD
Mailing Address - Street 2:PSYCHOLOGY SERVICE (116B)
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-1014
Mailing Address - Country:US
Mailing Address - Phone:269-966-5600
Mailing Address - Fax:269-660-6013
Practice Address - Street 1:5500 ARMSTRONG RD
Practice Address - Street 2:PSYCHOLOGY SERVICE (116B)
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-1014
Practice Address - Country:US
Practice Address - Phone:269-966-5600
Practice Address - Fax:269-660-6013
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042080A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical