Healthcare Provider Details

I. General information

NPI: 1568504785
Provider Name (Legal Business Name): ROBIN THERESA LUNSFORD SR. MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7658 TRICA AVE NE
BREMERTON WA
98311-4010
US

IV. Provider business mailing address

7658 TRICA AVE NE
BREMERTON WA
98311-4010
US

V. Phone/Fax

Practice location:
  • Phone: 360-801-0003
  • Fax: 360-801-0003
Mailing address:
  • Phone: 360-801-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-04-1817
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: