Healthcare Provider Details

I. General information

NPI: 1144790130
Provider Name (Legal Business Name): THERAPRACTIC MANAGEMENT SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 69TH ST STE D
LUBBOCK TX
79424-1646
US

IV. Provider business mailing address

5147 69TH ST STE D
LUBBOCK TX
79424-1646
US

V. Phone/Fax

Practice location:
  • Phone: 806-771-8808
  • Fax: 806-771-8809
Mailing address:
  • Phone: 806-771-8808
  • Fax: 806-771-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: PATRICK DAVID RANDOLPH
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 806-771-8808