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5147 69th St Ste D Lubbock TX 79424-1646 | |
| (806) 771-8808 | |
| (806) 771-8809 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 5147 69th St Ste D, Lubbock, Texas |
| Authorized Official Name and Position | Stephanie Stimac (OFFICE MANAGER) |
| Authorized Official Contact | 8067718808 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5147 69th St Ste D Lubbock TX 79424-1646 Ph: (806) 771-8808 | 5147 69th St Ste D Lubbock TX 79424-1646 Ph: (806) 771-8808 |
| NPI Number | 1740267285 |
|---|---|
| Provider Enumeration Date | 12/27/2005 |
| Last Update Date | 01/04/2024 |
| Certification Date | 01/02/2024 |
| Medicare PECOS PAC ID | 7810054632 |
|---|---|
| Medicare Enrollment ID | O20090324000102 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740267285 | NPI | - | NPPES |
| 0095MQ | Other | TX | BLUE CROSS BLUE SHIELD |
| 0992653 | Medicaid | TX | |
| 95074732 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 24796 (Texas) | Primary |
| Provider Name | Patrick D Randolph |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013060946 PECOS PAC ID: 3971584137 Enrollment ID: I20040525001193 |
Gabrielle K Keenum Ma Lpc Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6309 Indiana Ave Ste D, Lubbock, TX 79413 Phone: 806-790-1327 Fax: 806-863-3874 | |
Lubbock Accident & Injury Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5201 Indiana Ave, Lubbock, TX 79413 Phone: 806-793-7246 | |
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G. Gary Walker, Ph.d., P.c. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 5120 29th Dr Ste D, Lubbock, TX 79407 Phone: 806-798-8855 Fax: 806-792-5715 | |
Swmh Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4413 71st St Ste G101, Lubbock, TX 79424 Phone: 806-438-8089 | |
John Cobb, M.d., Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6502 Slide Road, Suite 311, Lubbock, TX 79424 Phone: 806-771-1386 Fax: 806-771-1388 |