Provider Demographics
NPI:1013259969
Name:STUFFLEBEAN, ROBIN GAYE (RN PC LICDC)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:GAYE
Last Name:STUFFLEBEAN
Suffix:
Gender:F
Credentials:RN PC LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1925 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4737
Mailing Address - Country:US
Mailing Address - Phone:419-557-5177
Mailing Address - Fax:419-557-5179
Practice Address - Street 1:76 ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1908
Practice Address - Country:US
Practice Address - Phone:419-448-9440
Practice Address - Fax:419-448-5155
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1200155101Y00000X
OHICDC081097101YA0400X
OHRN240023163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse