Provider Demographics
NPI:1811906290
Name:PLYMYER, ROBERT R (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:PLYMYER
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 E BROADWAY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2838
Mailing Address - Country:US
Mailing Address - Phone:520-302-4116
Mailing Address - Fax:855-831-9202
Practice Address - Street 1:6810 E BROADWAY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2838
Practice Address - Country:US
Practice Address - Phone:520-302-4116
Practice Address - Fax:855-831-9202
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003521103T00000X
AZLPC-15399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist