Provider Demographics
NPI:1548605645
Name:THOMASON, RANDY ERVIN JR (LCDC, LPC)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:ERVIN
Last Name:THOMASON
Suffix:JR
Gender:M
Credentials:LCDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4091 SUMMERHILL SQ
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2768
Mailing Address - Country:US
Mailing Address - Phone:903-792-8887
Mailing Address - Fax:
Practice Address - Street 1:3930 GALLERIA OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4670
Practice Address - Country:US
Practice Address - Phone:903-336-3484
Practice Address - Fax:903-336-3484
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9571101YA0400X
TX83076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)