Provider Demographics
NPI:1225362494
Name:SORENSEN, ROBERT MICHAEL (MA,LPC-S)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:MA,LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 HUEBNER RD
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1558
Mailing Address - Country:US
Mailing Address - Phone:210-877-9871
Mailing Address - Fax:210-641-2099
Practice Address - Street 1:9150 HUEBNER RD
Practice Address - Street 2:STE 210
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1558
Practice Address - Country:US
Practice Address - Phone:210-877-9871
Practice Address - Fax:210-641-2099
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60898101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2048126 02Medicaid