MEDICARE: THEODORE EDWARD ROBINSON LPC

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	101YM0800X	Mental Health Counselor	6094	OK

General Provider Information

NPI Number	:	1568658011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE EDWARD ROBINSON LPC

Provider Business Mailing Address
First Line	:	2035A W HOUSTON ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-8792
Country	:	US
Telephone Number	:	918-851-7190
Fax Number	:	918-560-1399

Provider Business Practice Location Address
First Line	:	2035A W HOUSTON ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-8792
Country	:	US
Telephone Number	:	918-505-4367
Fax Number	:

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

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	10/13/2022

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