Healthcare Provider Details

I. General information

NPI: 1003131079
Provider Name (Legal Business Name): GALEN S ROBINSON MHPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 E CHURCH ST
WARREN AR
71671
US

IV. Provider business mailing address

790 ROBERTS DRIVE
MONTICELLO AR
71655-5723
US

V. Phone/Fax

Practice location:
  • Phone: 870-226-5856
  • Fax: 870-226-6208
Mailing address:
  • Phone: 870-367-9731
  • Fax: 870-460-6133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: