Healthcare Provider Details

I. General information

NPI: 1376313031
Provider Name (Legal Business Name): ROBERT BOYD SEARS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E MAIN ST
GREENVILLE OH
45331-1913
US

IV. Provider business mailing address

427 LEXINGTON AVE
DAYTON OH
45402-6047
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-1635
  • Fax:
Mailing address:
  • Phone: 330-687-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2405944
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: