MEDICARE: DR. WILLIAM RANDOLPH BILLINGSLEY PH.D.

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
1	103TC0700X	Clinical Psychologist	2-3146	TX
2	103T00000X	Psychologist	2-3146	TX
3	103TH0100X	Health Service Psychologist	2-3146	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750401972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM RANDOLPH BILLINGSLEY PH.D.

Provider Business Mailing Address
First Line	:	1810 8TH AVE STE B-10
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1352
Country	:	US
Telephone Number	:	817-688-3788
Fax Number	:	817-738-8866

Provider Business Practice Location Address
First Line	:	1810 8TH AVE STE B-10
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1352
Country	:	US
Telephone Number	:	817-688-3788
Fax Number	:	817-738-8866

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	12/04/2025

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