Provider Demographics
NPI:1336322536
Name:ONE STOP MEDICAL LLC
Entity Type:Organization
Organization Name:ONE STOP MEDICAL LLC
Other - Org Name:LONNIE DEGGINS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:FARENTHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:281-964-7269
Mailing Address - Street 1:1442 KINGWOOD DR # 103
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3040
Mailing Address - Country:US
Mailing Address - Phone:281-964-7269
Mailing Address - Fax:832-415-2681
Practice Address - Street 1:1442 KINGWOOD DR # 103
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3040
Practice Address - Country:US
Practice Address - Phone:281-964-7269
Practice Address - Fax:832-415-2681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty