Provider Demographics
NPI:1790006054
Name:CRISP, ROBIN (LCPC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:CRISP
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E WASHINGTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3968
Mailing Address - Country:US
Mailing Address - Phone:406-260-3395
Mailing Address - Fax:406-752-8849
Practice Address - Street 1:30 E WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3968
Practice Address - Country:US
Practice Address - Phone:406-260-3395
Practice Address - Fax:406-752-8849
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT734101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional