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NPI Code Detail

MEDICARE: MR. DUDLEY T FARENTHOLD LCDC LPC LCSW

MEDICARE: MR. DUDLEY T FARENTHOLD LCDC LPC LCSW
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
1171M00000XCase Manager/Care Coordinator23834 LCSWTX
2101YP2500XProfessional Counselor14943TX
31041C0700XClinical Social WorkerLCSW 23834TX
4101YA0400XAddiction (Substance Use Disorder) CounselorLCDC 797TX

General Provider Information

NPI Number : 1225193261
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DUDLEY T FARENTHOLD LCDC LPC LCSW
Provider Business Mailing Address
First Line : PO BOX 451485
Second Line :
City : HOUSTON
State : TX
Zip : 77245-1485
Country : US
Telephone Number : 713-433-0528
Fax Number : 832-539-1299
Provider Business Practice Location Address
First Line : 5331 W OREM DR
Second Line :
City : HOUSTON
State : TX
Zip : 77045-5036
Country : US
Telephone Number : 713-433-0528
Fax Number : 832-539-1299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2006
Last Update Date : 03/03/2014

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