Provider Demographics
NPI:1790207389
Name:ROBBINS, RICHARD TODD JR
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:TODD
Last Name:ROBBINS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9011 OLD HIGHWAY 99 SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1088
Mailing Address - Country:US
Mailing Address - Phone:360-280-9145
Mailing Address - Fax:
Practice Address - Street 1:4003 PAHOA AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-4660
Practice Address - Country:US
Practice Address - Phone:360-280-9145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-22-58260103K00000X, 103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician