Provider Demographics
NPI:1275915134
Name:SKIPPER, ROBERT (MDIV, LPCC, LICDC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:SKIPPER
Suffix:
Gender:M
Credentials:MDIV, LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 DRYDEN RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1661
Mailing Address - Country:US
Mailing Address - Phone:937-299-9005
Mailing Address - Fax:
Practice Address - Street 1:2621 DRYDEN RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1661
Practice Address - Country:US
Practice Address - Phone:937-299-9005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH943997101YA0400X
11131101YP1600X
OHE0002739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral