Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 33542 | TX |
NPI | 1114250321 |
---|---|
Provider Name | Dianne Tracy Robinson |
First Address | San Antonio, TX 78223-3002 |
Second Address | San Antonio, TX 78223-3002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2009 |
Last Update Date | 08/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33542 | TEXAS STATE BOARD OF EXAMINERS OF PSYCHOLOGIST (01) | TX |