Healthcare Provider Details

I. General information

NPI: 1144249814
Provider Name (Legal Business Name): JACLYNN ROBINSON QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 SAMUELL BLVD
DALLAS TX
75228-6828
US

IV. Provider business mailing address

5990 ARAPAHO RD APT 5O
DALLAS TX
75248-3715
US

V. Phone/Fax

Practice location:
  • Phone: 214-381-7070
  • Fax: 214-381-7071
Mailing address:
  • Phone: 214-517-8803
  • Fax: 972-392-3662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: