Provider Demographics
NPI:1164668729
Name:JEWELL, ROBERT TIMOTHY (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:TIMOTHY
Last Name:JEWELL
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3104
Mailing Address - Country:US
Mailing Address - Phone:936-633-2730
Mailing Address - Fax:
Practice Address - Street 1:1514 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3104
Practice Address - Country:US
Practice Address - Phone:936-633-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8523101Y00000X
TX18718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor