Healthcare Provider Details

I. General information

NPI: 1235839689
Provider Name (Legal Business Name): ROBYN N EUBANK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 W KILGORE AVE
MUNCIE IN
47304-4811
US

IV. Provider business mailing address

3812 W KILGORE AVE
MUNCIE IN
47304-4811
US

V. Phone/Fax

Practice location:
  • Phone: 765-748-8112
  • Fax:
Mailing address:
  • Phone: 765-748-8112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ROBYN EUBANK
Title or Position: OWNER
Credential: PSYD, HSPP
Phone: 765-748-8112