| Randi M Drake, Llc | |
|
300 E Broad St Forney TX 75126-9164 | |
| (972) 515-0834 | |
| Not Available |
| Full Name | Randi M Drake, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 300 E Broad St, Forney, Texas |
| Authorized Official Name and Position | Randi Michelle Wright (MANAGING MEMBER) |
| Authorized Official Contact | 9725150834 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Randi M Drake, Llc Po Box 1987 Forney TX 75126-1987 Ph: (972) 515-0834 | Randi M Drake, Llc 300 E Broad St Forney TX 75126-9164 Ph: (972) 515-0834 |
| NPI Number | 1376986729 |
|---|---|
| Provider Enumeration Date | 04/15/2013 |
| Last Update Date | 08/18/2015 |
| Medicare PECOS PAC ID | 5496996449 |
|---|---|
| Medicare Enrollment ID | O20130802000370 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376986729 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 52553 (Texas) | Primary |
| Provider Name | Randi M Wright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336445436 PECOS PAC ID: 5799926754 Enrollment ID: I20130802000621 |
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