Provider Demographics
NPI:1790903169
Name:FINE, ROBERT WESLEY (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WESLEY
Last Name:FINE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 PHILLIPS DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-6048
Mailing Address - Country:US
Mailing Address - Phone:214-499-8755
Mailing Address - Fax:
Practice Address - Street 1:1700 ALMA DR STE 305
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6956
Practice Address - Country:US
Practice Address - Phone:214-499-8755
Practice Address - Fax:972-578-2803
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health