Provider Demographics
NPI:1316577711
Name:SEPULVEDA, ROBERT (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SEPULVEDA
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 1:640 SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1603
Mailing Address - Country:US
Mailing Address - Phone:269-471-5968
Mailing Address - Fax:
Practice Address - Street 1:640 SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1603
Practice Address - Country:US
Practice Address - Phone:224-730-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional