Provider Demographics
NPI:1720154537
Name:HARVEY, ROBERT BROOKS (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BROOKS
Last Name:HARVEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4219
Mailing Address - Country:US
Mailing Address - Phone:940-322-9456
Mailing Address - Fax:940-322-6759
Practice Address - Street 1:1819 8TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4212
Practice Address - Country:US
Practice Address - Phone:940-322-9456
Practice Address - Fax:940-322-6759
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19878101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178018101Medicaid