Provider Demographics
NPI:1457812612
Name:WOODRING, RANDY LEE (LPC)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:LEE
Last Name:WOODRING
Suffix:
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 1:8241 SOUTHWESTERN BLVD APT 2040
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-9321
Mailing Address - Country:US
Mailing Address - Phone:972-342-3772
Mailing Address - Fax:
Practice Address - Street 1:13150 COIT RD # 313
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5792
Practice Address - Country:US
Practice Address - Phone:972-342-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty