Provider Demographics
NPI:1700217171
Name:DR ROBERT M DANE COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:DR ROBERT M DANE COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC-S, LCDC
Authorized Official - Phone:512-413-0651
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78680-0639
Mailing Address - Country:US
Mailing Address - Phone:512-413-0651
Mailing Address - Fax:512-368-2801
Practice Address - Street 1:1315 SAM BASS CIR
Practice Address - Street 2:SUITE B3
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2932
Practice Address - Country:US
Practice Address - Phone:512-413-0651
Practice Address - Fax:512-368-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty