Provider Demographics
NPI:1376617720
Name:FORTNEY, ROBERT BROWN (NCC, LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BROWN
Last Name:FORTNEY
Suffix:
Gender:M
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 62ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1206
Mailing Address - Country:US
Mailing Address - Phone:806-790-9090
Mailing Address - Fax:806-792-6156
Practice Address - Street 1:3302 34TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-3232
Practice Address - Country:US
Practice Address - Phone:806-790-9090
Practice Address - Fax:806-792-6156
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18987101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184162901Medicaid