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General NPI Number Information
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NPI Number | 1225193261
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Entity Type | Individual
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Provider Name | DUDLEY T FARENTHOLD LCDC LPC LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 5331 W OREM DR
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City | HOUSTON
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State | TX
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Zip | 77045-5036
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Country | US
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Telephone | 713-433-0528
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Fax | 832-539-1299
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Provider Business Mailing Address
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Address Line | PO BOX 451485
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City | HOUSTON
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State | TX
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Zip | 77245-1485
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Country | US
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Telephone | 713-433-0528
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Fax | 832-539-1299
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 23834 LCSW
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 14943
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW 23834
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDC 797
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License Number State | TX
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