Provider Demographics
NPI:1003131079
Name:ROBINSON, GALEN S (MHPP)
Entity Type:Individual
Prefix:
First Name:GALEN
Middle Name:S
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 ROBERTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-5723
Mailing Address - Country:US
Mailing Address - Phone:870-367-9731
Mailing Address - Fax:870-460-6133
Practice Address - Street 1:1404 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671
Practice Address - Country:US
Practice Address - Phone:870-226-5856
Practice Address - Fax:870-226-6208
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator