Provider Demographics
NPI:1750651840
Name:MITCHELL-ROBBINS, MICHELLE DIANNE (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANNE
Last Name:MITCHELL-ROBBINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 S POLK ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-4228
Mailing Address - Country:US
Mailing Address - Phone:806-349-5633
Mailing Address - Fax:806-337-1036
Practice Address - Street 1:1501 S POLK ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-4228
Practice Address - Country:US
Practice Address - Phone:806-349-5633
Practice Address - Fax:806-337-1036
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289213501Medicaid