Provider Demographics
NPI:1932731205
Name:DOUGLAS, ROBIN GAYLE (VSD, JST)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:GAYLE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:VSD, JST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 COURT RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-4462
Mailing Address - Country:US
Mailing Address - Phone:281-248-6109
Mailing Address - Fax:
Practice Address - Street 1:6430 COURT RD BLDG A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-4462
Practice Address - Country:US
Practice Address - Phone:281-248-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 372600000X, 171M00000X
TXRGAYLE82251C00000X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No372600000XNursing Service Related ProvidersAdult Companion
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
RGAYLE82VSDOtherUNT WORKFORCE INCLUSION & SUSTAINABLE EMPLOYMENT VOCATIONAL SERVICE DIRECTOR
TXRGAYLE82VSDOtherUNT WORKFORCE INCLUSION & SUSTAINABLE EMPLOYMENT VOCATIONAL SERVICE DIRECTOR
TXRGAYLE82JSTOtherUNT WORKFORCE INCLUSION & SUSTAINABLE EMPLOYMENT JOB SKILLS TRAINER