Provider Demographics
NPI:1710134200
Name:BOTS, ROBINE (MS)
Entity Type:Individual
Prefix:
First Name:ROBINE
Middle Name:
Last Name:BOTS
Suffix:
Gender:F
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:PO BOX 2347
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-2347
Mailing Address - Country:US
Mailing Address - Phone:541-390-2769
Mailing Address - Fax:
Practice Address - Street 1:16054 PERIT HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-2632
Practice Address - Country:US
Practice Address - Phone:541-390-2769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORT0946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health