Provider Demographics
NPI:1043426455
Name:HELLER, RANDY JILL (MED, LMHC,LMFT)
Entity type:Individual
Prefix:MS
First Name:RANDY
Middle Name:JILL
Last Name:HELLER
Suffix:
Gender:F
Credentials:MED, LMHC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3355
Mailing Address - Country:US
Mailing Address - Phone:954-263-6566
Mailing Address - Fax:954-476-9245
Practice Address - Street 1:2 S UNIVERSITY DR
Practice Address - Street 2:SUITE 304
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3355
Practice Address - Country:US
Practice Address - Phone:954-263-6566
Practice Address - Fax:954-476-9245
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2181106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist