Provider Demographics
NPI:1902499882
Name:BAIRD, RANDALL FREDRICK (LMFT)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:FREDRICK
Last Name:BAIRD
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E TAHQUITZ CANYON WAY STE C4
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7062
Mailing Address - Country:US
Mailing Address - Phone:858-472-6369
Mailing Address - Fax:
Practice Address - Street 1:1900 E TAHQUITZ CANYON WAY STE C4
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7062
Practice Address - Country:US
Practice Address - Phone:858-472-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121893106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist