MEDICARE: MS. ROBIN DICKEY LPC-INTERN

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	67798	TX

General Provider Information

NPI Number	:	1790073930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROBIN DICKEY LPC-INTERN

Provider Business Mailing Address
First Line	:	3113 S UNIVERSITY DR
Second Line	:	SUITE 201
City	:	FORT WORTH
State	:	TX
Zip	:	76109-5616
Country	:	US
Telephone Number	:	817-683-1457
Fax Number	:

Provider Business Practice Location Address
First Line	:	3113 S UNIVERSITY DR
Second Line	:	SUITE 201
City	:	FORT WORTH
State	:	TX
Zip	:	76109-5616
Country	:	US
Telephone Number	:	817-683-1457
Fax Number	:

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

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	07/20/2011

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