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General NPI Number Information
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NPI Number | 1740267285
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Entity Type | Organization
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Legal Business Name | PATRICK D RANDOLPH PHD INC
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 5147 69TH ST STE D
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City | LUBBOCK
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State | TX
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Zip | 79424-1646
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Country | US
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Telephone | 806-771-8808
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Fax | 806-771-8809
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Provider Business Mailing Address
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Address Line | 5147 69TH ST STE D
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City | LUBBOCK
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State | TX
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Zip | 79424-1646
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Country | US
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Telephone | 806-771-8808
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Fax | 806-771-8809
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STEPHANIE STIMAC
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Credential |
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Telephone | 806-771-8808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 24796
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License Number State | TX
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