Healthcare Provider Details

I. General information

NPI: 1184848608
Provider Name (Legal Business Name): ROBBIN TODD HOLLEY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W JACKSON RD
CARROLLTON TX
75006-1316
US

IV. Provider business mailing address

1100 W JACKSON RD
CARROLLTON TX
75006-1316
US

V. Phone/Fax

Practice location:
  • Phone: 972-242-2182
  • Fax: 972-242-2932
Mailing address:
  • Phone: 972-242-2182
  • Fax: 972-242-2932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12587
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: