Provider Demographics
NPI:1982997367
Name:HEINRICH, ROBIN RAY (MA LPC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:RAY
Last Name:HEINRICH
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85358-1303
Mailing Address - Country:US
Mailing Address - Phone:928-231-0435
Mailing Address - Fax:
Practice Address - Street 1:880 S VULTURE MINE RD
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1160
Practice Address - Country:US
Practice Address - Phone:928-231-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional