Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 943997 | OH |
N | 101YP1600X | Pastoral Counselor | 11131 | |
Y | 101YP2500X | Professional Counselor | E0002739 | OH |
NPI | 1275915134 |
---|---|
Provider Name | Mr. Robert Skipper |
First Address | Moraine, OH 45439-1661 |
Second Address | Moraine, OH 45439-1661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2015 |
Last Update Date | 26/06/2015 |