Provider Demographics
NPI:1568584381
Name:ROLLINS, GROVER CLEAVON (LPC)
Entity Type:Individual
Prefix:
First Name:GROVER
Middle Name:CLEAVON
Last Name:ROLLINS
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:PO BOX 720879
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0879
Mailing Address - Country:US
Mailing Address - Phone:956-655-7872
Mailing Address - Fax:956-627-1253
Practice Address - Street 1:2900 N J ST APT 206
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1445
Practice Address - Country:US
Practice Address - Phone:956-655-7872
Practice Address - Fax:956-627-1253
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18335101YP2500X
TX38840103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163689601Medicaid
TX159360002Medicaid