Healthcare Provider Details

I. General information

NPI: 1225294234
Provider Name (Legal Business Name): ROBIN CAROL POPE SANTA TERESA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROBIN CAROL POPE LCP

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6028 MONDAVI LN
EUGENE OR
97402-7532
US

IV. Provider business mailing address

6028 MONDAVI LN
EUGENE OR
97402-7532
US

V. Phone/Fax

Practice location:
  • Phone: 502-827-6207
  • Fax: 859-247-0412
Mailing address:
  • Phone: 502-827-6207
  • Fax: 859-247-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6763
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220680
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1739
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1131
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3424
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: