Provider Demographics
NPI:1942561832
Name:PINE, ROBERT ANTHONY (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:PINE
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 OLD SHEPARD PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5279
Mailing Address - Country:US
Mailing Address - Phone:469-964-5687
Mailing Address - Fax:
Practice Address - Street 1:4601 OLD SHEPARD PL
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5251
Practice Address - Country:US
Practice Address - Phone:469-964-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64634101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional