Provider Demographics
NPI:1780621243
Name:RANDALL, CHRISTINE V (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:V
Last Name:RANDALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:V
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:25810 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2016
Mailing Address - Country:US
Mailing Address - Phone:281-364-0067
Mailing Address - Fax:281-364-0712
Practice Address - Street 1:25810 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2016
Practice Address - Country:US
Practice Address - Phone:281-364-0067
Practice Address - Fax:281-364-0712
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31592103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7235784OtherAETNA ID