Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 74753 | TX |
NPI | 1003327677 |
---|---|
Provider Name | Corey Robinson |
First Address | Texarkana, TX 75501-7875 |
Second Address | Texarkana, TX 75501-2788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2017 |
Last Update Date | 23/10/2017 |