Provider Demographics
NPI:1316018484
Name:CHEEK, RANDELL J (MFT)
Entity type:Individual
Prefix:MR
First Name:RANDELL
Middle Name:J
Last Name:CHEEK
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2932
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94953-2932
Mailing Address - Country:US
Mailing Address - Phone:707-778-1720
Mailing Address - Fax:707-765-6101
Practice Address - Street 1:111 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2330
Practice Address - Country:US
Practice Address - Phone:707-778-1720
Practice Address - Fax:707-765-6101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist