Healthcare Provider Details

I. General information

NPI: 1780820779
Provider Name (Legal Business Name): ROBIN E. STILL LPC, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WEST STEVE OWENS BLVD.
MIAMI OK
74354
US

IV. Provider business mailing address

P.O. BOX 1271 NORTHEASTERN OKLANHOMA COUNCIL ON ALCOHOLISM, INC.
MIAMI OK
74355-1271
US

V. Phone/Fax

Practice location:
  • Phone: 918-542-2845
  • Fax: 918-542-2848
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number116
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: