Provider Demographics
NPI:1992326821
Name:KITCHEN, RANDALL EUGENE (LPC, LCDC)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:EUGENE
Last Name:KITCHEN
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 BAYBERRY TRL
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-6858
Mailing Address - Country:US
Mailing Address - Phone:214-632-0002
Mailing Address - Fax:
Practice Address - Street 1:6950 SHADY LN
Practice Address - Street 2:
Practice Address - City:SCURRY
Practice Address - State:TX
Practice Address - Zip Code:75158-2831
Practice Address - Country:US
Practice Address - Phone:972-452-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14015101YA0400X
TX78196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty