Provider Demographics
NPI:1730437112
Name:PITTENGER, RANDY (LCSW, LMFT)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:PITTENGER
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 WOODLAND TRL
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-6221
Mailing Address - Country:US
Mailing Address - Phone:254-541-6212
Mailing Address - Fax:
Practice Address - Street 1:292 WOODLAND TRL
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-6221
Practice Address - Country:US
Practice Address - Phone:254-541-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117391041C0700X
TX1133106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist