Provider Demographics
NPI:1821118605
Name:SEELEY, ROBIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:SEELEY
Suffix:
Gender:F
Credentials:PHD
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 862
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0029
Mailing Address - Country:US
Mailing Address - Phone:541-601-2968
Mailing Address - Fax:541-488-5011
Practice Address - Street 1:815 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6713
Practice Address - Country:US
Practice Address - Phone:541-601-2968
Practice Address - Fax:541-488-5011
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1573103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR119433Medicare ID - Type Unspecified