Provider Demographics
NPI:1225193261
Name:FARENTHOLD, DUDLEY T (LCDC LPC LCSW)
Entity Type:Individual
Prefix:MR
First Name:DUDLEY
Middle Name:T
Last Name:FARENTHOLD
Suffix:
Gender:M
Credentials:LCDC LPC LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 451485
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77245-1485
Mailing Address - Country:US
Mailing Address - Phone:713-433-0528
Mailing Address - Fax:832-539-1299
Practice Address - Street 1:5331 W OREM DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-5036
Practice Address - Country:US
Practice Address - Phone:713-433-0528
Practice Address - Fax:832-539-1299
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23834 LCSW171M00000X
TX14943101YP2500X
TXLCSW 238341041C0700X
TXLCDC 797101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)