MEDICARE: DR. BOBBY L. STINSON II PSYD JD LICDC-S ABPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	5715	OH

General Provider Information

NPI Number	:	1083782585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOBBY L. STINSON II PSYD JD LICDC-S ABPP

Provider Business Mailing Address
First Line	:	30 W SPRING ST
Second Line	:	5TH FLOOR
City	:	COLUMBUS
State	:	OH
Zip	:	43215-2216
Country	:	US
Telephone Number	:	614-728-3732
Fax Number	:	614-895-6801

Provider Business Practice Location Address
First Line	:	30 W SPRING ST
Second Line	:	5TH FLOOR
City	:	COLUMBUS
State	:	OH
Zip	:	43215-2216
Country	:	US
Telephone Number	:	614-728-3732
Fax Number	:	614-895-6801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	06/03/2015

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