Provider Demographics
NPI:1942602826
Name:MCILLWAIN, ROBBIE (MHPP)
Entity Type:Individual
Prefix:MR
First Name:ROBBIE
Middle Name:
Last Name:MCILLWAIN
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4878
Mailing Address - Country:US
Mailing Address - Phone:870-565-2321
Mailing Address - Fax:
Practice Address - Street 1:2420 LINWOOD DR STE 1&2
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-6122
Practice Address - Country:US
Practice Address - Phone:870-236-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health