Provider Demographics
NPI:1407033004
Name:DRYDEN, ROBERT DWAYNE JR (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DWAYNE
Last Name:DRYDEN
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2607
Mailing Address - Country:US
Mailing Address - Phone:806-766-0310
Mailing Address - Fax:806-744-9580
Practice Address - Street 1:1602 10TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-2607
Practice Address - Country:US
Practice Address - Phone:806-766-0310
Practice Address - Fax:806-744-9580
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX63612OtherLPC LICENSE NUMBER