Provider Demographics
NPI:1821139890
Name:MCILVEEN, DAISY ROBINSON (MED,LPC,LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:ROBINSON
Last Name:MCILVEEN
Suffix:
Gender:F
Credentials:MED,LPC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 WOODCREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8793
Mailing Address - Country:US
Mailing Address - Phone:979-846-5626
Mailing Address - Fax:979-846-5141
Practice Address - Street 1:1501 WOODCREEK DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8793
Practice Address - Country:US
Practice Address - Phone:979-846-5626
Practice Address - Fax:979-846-5141
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6142101YP2500X
TX06142106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
23367660OtherCPS