| Doctor Name: | MR. RON DEWAYNE RANDALL |
| NPI Number: | 1932205705 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MED LPC LMFT |
| License Number: | 5254 |
| Business Practice Address: | 2707 Airport Freeway Suite 213 Fort Worth, TX - 761112370 |
| Business Phone Number: | 8179209779 |
| Business Fax Number: | 8179209553 |
| Mailing Address: | 3404 Martin Lydon, FORT WORTH |
| State: | TX |
| Postal Code: | 761331419 |
| Phone Number: | 8179275462 |
| Fax Number: | 8179209553 |
| NPI Enumeration Date: | 09/16/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 5254 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |