Provider Demographics
NPI:1770815649
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:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LPC
Authorized Official - Phone:361-906-0676
Mailing Address - Street 1:5656 S STAPLES ST
Mailing Address - Street 2:STE 330
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4693
Mailing Address - Country:US
Mailing Address - Phone:361-906-0676
Mailing Address - Fax:361-906-0371
Practice Address - Street 1:5656 S STAPLES ST
Practice Address - Street 2:STE 330
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4693
Practice Address - Country:US
Practice Address - Phone:361-906-0676
Practice Address - Fax:361-906-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18362101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty