Provider Demographics
NPI:1114102183
Name:ROBLES, FREDY (LPCC, LCDC III)
Entity Type:Individual
Prefix:MR
First Name:FREDY
Middle Name:
Last Name:ROBLES
Suffix:
Gender:M
Credentials:LPCC, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 BEALL AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691
Mailing Address - Country:US
Mailing Address - Phone:330-262-7836
Mailing Address - Fax:330-262-2867
Practice Address - Street 1:521 BEALL AVENUE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691
Practice Address - Country:US
Practice Address - Phone:330-262-7836
Practice Address - Fax:330-262-2867
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0601063101YP2500X
OH121059101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)