Provider Demographics
NPI:1770910903
Name:PRICE, ROBERT CASEY JR (MCOUN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CASEY
Last Name:PRICE
Suffix:JR
Gender:M
Credentials:MCOUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:DC
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-234-4722
Mailing Address - Fax:
Practice Address - Street 1:110 S 19TH AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:DC
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-234-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5359101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional