Individual
RANDIE SHANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IMFT
Contact information
Practice address
2460 FAIRMOUNT BLVD, #326, CLEVELAND HEIGHTS, OH 44106
(917) 478-1254
Mailing address
2460 FAIRMOUNT BLVD, #326, CLEVELAND HEIGHTS, OH 44106
(917) 478-1254
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
001248
NY
106H00000X
Marriage & Family Therapist
F.1700018
OH
106H00000X
Marriage & Family Therapist
Primary
F1700018
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0239788
—
OH
Enumeration date
09/25/2015
Last updated
12/12/2018
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