Provider Demographics
NPI:1568504785
Name:LUNSFORD, ROBIN THERESA SR (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:THERESA
Last Name:LUNSFORD
Suffix:SR
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7658 TRICA AVE NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-4010
Mailing Address - Country:US
Mailing Address - Phone:360-801-0003
Mailing Address - Fax:
Practice Address - Street 1:7658 TRICA AVE NE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-4010
Practice Address - Country:US
Practice Address - Phone:360-801-0003
Practice Address - Fax:360-801-0003
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TM1800X
1-04-1817103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities