Provider Demographics
NPI:1689885980
Name:MOBLEY, ROBERT W (MA LLPCAAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:MA LLPCAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12754 C DR N
Mailing Address - Street 2:
Mailing Address - City:CERESCO
Mailing Address - State:MI
Mailing Address - Zip Code:49033-9776
Mailing Address - Country:US
Mailing Address - Phone:269-274-7830
Mailing Address - Fax:
Practice Address - Street 1:12754 C DR N
Practice Address - Street 2:
Practice Address - City:CERESCO
Practice Address - State:MI
Practice Address - Zip Code:49033-9776
Practice Address - Country:US
Practice Address - Phone:269-274-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013578103TC1900X
MIC-00021101YA0400X
MI6401010471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional