Provider Demographics
NPI:1578862470
Name:TEVIS, ROBERT HENRY (M ED LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HENRY
Last Name:TEVIS
Suffix:
Gender:M
Credentials:M ED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8911
Mailing Address - Country:US
Mailing Address - Phone:570-389-1241
Mailing Address - Fax:
Practice Address - Street 1:816 CENTRAL RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8976
Practice Address - Country:US
Practice Address - Phone:570-387-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional