Provider Demographics
NPI:1184946725
Name:MARSHALL, ROBERT WAYNE (LPC-S)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WAYNE
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:LPC-S
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 12
Mailing Address - Street 2:
Mailing Address - City:BOYS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:79010-0012
Mailing Address - Country:US
Mailing Address - Phone:806-549-3530
Mailing Address - Fax:
Practice Address - Street 1:28 TASCOSA TRAIL
Practice Address - Street 2:
Practice Address - City:BOYS RANCH
Practice Address - State:TX
Practice Address - Zip Code:79010-0012
Practice Address - Country:US
Practice Address - Phone:806-549-3530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17304101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17304OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS