Provider Demographics
NPI:1760618946
Name:SPOUDAZO RESOURCES OF SOUTH TEXAS
Entity Type:Organization
Organization Name:SPOUDAZO RESOURCES OF SOUTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LEAD THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:361-882-4808
Mailing Address - Street 1:710 BUFFALO ST STE 311
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-1910
Mailing Address - Country:US
Mailing Address - Phone:361-882-4808
Mailing Address - Fax:361-882-4846
Practice Address - Street 1:710 BUFFALO ST STE 311
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-1910
Practice Address - Country:US
Practice Address - Phone:361-882-4808
Practice Address - Fax:361-882-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18362101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty