Provider Demographics
NPI:1972791861
Name:DANE, ROBERT MICHAEL (PHD, LPC-S, LCDC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:DANE
Suffix:
Gender:M
Credentials:PHD, LPC-S, LCDC
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 639
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78680-0639
Mailing Address - Country:US
Mailing Address - Phone:512-413-0651
Mailing Address - Fax:512-244-2470
Practice Address - Street 1:1315 SAM BASS CIRCLE
Practice Address - Street 2:SUITE B3
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4168
Practice Address - Country:US
Practice Address - Phone:512-413-0651
Practice Address - Fax:512-244-2470
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10667101YA0400X
TX14671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7853LCOtherBLUECROSS BLUESHIELD