Provider Demographics
NPI:1881757532
Name:BEAUREGARD, ROBIN NICOLE (DMIN, LPC)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:NICOLE
Last Name:BEAUREGARD
Suffix:
Gender:F
Credentials:DMIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 COUNTY ROAD 2730
Mailing Address - Street 2:
Mailing Address - City:LOMETA
Mailing Address - State:TX
Mailing Address - Zip Code:76853-4907
Mailing Address - Country:US
Mailing Address - Phone:512-734-2544
Mailing Address - Fax:254-699-7309
Practice Address - Street 1:3120 COUNTY ROAD 2730
Practice Address - Street 2:
Practice Address - City:LOMETA
Practice Address - State:TX
Practice Address - Zip Code:76853-4907
Practice Address - Country:US
Practice Address - Phone:512-734-2544
Practice Address - Fax:254-699-7309
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15615101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0280299-02Medicaid