Provider Demographics
NPI:1144249814
Name:ROBINSON, JACLYNN (QMHP)
Entity type:Individual
Prefix:
First Name:JACLYNN
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5990 ARAPAHO RD
Mailing Address - Street 2:APT 5O
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-3715
Mailing Address - Country:US
Mailing Address - Phone:214-517-8803
Mailing Address - Fax:972-392-3662
Practice Address - Street 1:4701 SAMUELL BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-6828
Practice Address - Country:US
Practice Address - Phone:214-381-7070
Practice Address - Fax:214-381-7071
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health