Healthcare Provider Details

I. General information

NPI: 1689885980
Provider Name (Legal Business Name): ROBERT W MOBLEY M.A. L.L.P.C.A.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12754 C DR N
CERESCO MI
49033-9776
US

IV. Provider business mailing address

12754 C DR N
CERESCO MI
49033-9776
US

V. Phone/Fax

Practice location:
  • Phone: 269-274-7830
  • Fax:
Mailing address:
  • Phone: 269-274-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-00021
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010471
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301013578
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: