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NPI Code Detail

MEDICARE: MR. RANDALL WILLIAM CRIBBS

MEDICARE: MR. RANDALL WILLIAM CRIBBS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor82543TX

General Provider Information

NPI Number : 1568034312
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDALL WILLIAM CRIBBS
Provider Business Mailing Address
First Line : 855 TEXAS ST STE 105
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-4574
Country : US
Telephone Number : 682-288-9292
Fax Number :
Provider Business Practice Location Address
First Line : 855 TEXAS ST STE 105
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-4574
Country : US
Telephone Number : 682-288-9292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2021
Last Update Date : 07/12/2021

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Directions to “ MR. RANDALL WILLIAM CRIBBS ” Practice Location

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