Organization
PATRICK D RANDOLPH PHD INC
Active
Other names
Lighthouse Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE STIMAC (OFFICE MANAGER)
(806) 771-8808
Entity
Organization
Contact information
Practice address
5147 69TH ST STE D, LUBBOCK, TX 79424-1646
(806) 771-8808
(806) 771-8809
Mailing address
5147 69TH ST STE D, LUBBOCK, TX 79424-1646
(806) 771-8808
(806) 771-8809
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
24796
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0095MQ
BLUE CROSS BLUE SHIELD
TX
05
—
0992653
—
TX
05
—
95074732
—
NM
Enumeration date
12/27/2005
Last updated
01/04/2024
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