Provider Demographics
NPI:1659673614
Name:THEEMLNG, ROBERT BRANDT (MS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRANDT
Last Name:THEEMLNG
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8506
Mailing Address - Country:US
Mailing Address - Phone:714-619-0208
Mailing Address - Fax:
Practice Address - Street 1:1615 E 17TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8529
Practice Address - Country:US
Practice Address - Phone:714-619-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15681106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist