Provider Demographics
NPI:1770772386
Name:HESTER, WILLIAM RANDOLPH JR (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RANDOLPH
Last Name:HESTER
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 FOREST LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-7954
Mailing Address - Country:US
Mailing Address - Phone:972-841-7949
Mailing Address - Fax:972-551-2667
Practice Address - Street 1:2301 FOREST LN
Practice Address - Street 2:SUITE 104
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7954
Practice Address - Country:US
Practice Address - Phone:972-841-7949
Practice Address - Fax:972-551-2667
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21621103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2010137081Medicare NSC