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General NPI Number Information
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NPI Number | 1932205705
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Entity Type | Individual
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Provider Name | RON DEWAYNE RANDALL MED LPC LMFT
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 2707 AIRPORT FREEWAY SUITE 213
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City | FORT WORTH
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State | TX
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Zip | 76111-2370
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Country | US
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Telephone | 817-920-9779
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Fax | 817-920-9553
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Provider Business Mailing Address
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Address Line | 3404 MARTIN LYDON
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City | FORT WORTH
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State | TX
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Zip | 76133-1419
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Country | US
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Telephone | 817-927-5462
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Fax | 817-920-9553
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3617
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5254
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License Number State | TX
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