Provider Demographics
NPI:1003242264
Name:BUSBY-ROBINSON, PATRICIA (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BUSBY-ROBINSON
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38935-1312
Mailing Address - Country:US
Mailing Address - Phone:662-299-7336
Mailing Address - Fax:
Practice Address - Street 1:201 FULTON ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4324
Practice Address - Country:US
Practice Address - Phone:662-644-5111
Practice Address - Fax:662-590-0263
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01684361Medicaid