Provider Demographics
NPI:1134135866
Name:ROBINETT, BRUCE (LPC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:ROBINETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9407 DE CHENE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6309
Mailing Address - Country:US
Mailing Address - Phone:210-789-7220
Mailing Address - Fax:210-509-7766
Practice Address - Street 1:9407 DE CHENE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-6309
Practice Address - Country:US
Practice Address - Phone:210-789-7220
Practice Address - Fax:210-509-7766
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14451802Medicaid