Provider Demographics
NPI:1336406313
Name:ROBINSON, KIM ELIZABETH (PHD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ELIZABETH
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SCOTT AVE
Mailing Address - Street 2:SUITE 27
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4671
Mailing Address - Country:US
Mailing Address - Phone:940-761-9700
Mailing Address - Fax:940-761-9704
Practice Address - Street 1:1101 SCOTT AVE
Practice Address - Street 2:SUITE 27
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4671
Practice Address - Country:US
Practice Address - Phone:940-761-9700
Practice Address - Fax:940-761-9704
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36118103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical