Provider Demographics
NPI:1083782585
Name:STINSON, BOBBY L II (PSYD JD LICDC-S ABPP)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:L
Last Name:STINSON
Suffix:II
Gender:M
Credentials:PSYD JD LICDC-S ABPP
Other - Prefix:DR
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:STINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD JD LICDC-S ABPP
Mailing Address - Street 1:30 W SPRING ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-2216
Mailing Address - Country:US
Mailing Address - Phone:614-728-3732
Mailing Address - Fax:614-895-6801
Practice Address - Street 1:30 W SPRING ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2216
Practice Address - Country:US
Practice Address - Phone:614-728-3732
Practice Address - Fax:614-895-6801
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5715103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSTCP25871Medicare PIN