Provider Demographics
NPI:1336538537
Name:MAGILL, ROBERT (MA, CAADC, CCPG, LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MAGILL
Suffix:
Gender:M
Credentials:MA, CAADC, CCPG, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HILL ST
Mailing Address - Street 2:
Mailing Address - City:FORDLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65652-7153
Mailing Address - Country:US
Mailing Address - Phone:717-219-5711
Mailing Address - Fax:717-219-5712
Practice Address - Street 1:55 NEW ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2826
Practice Address - Country:US
Practice Address - Phone:717-219-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009552101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134397847OtherNPI
23-2446220OtherEMPLOYER'S TAX ID