Basic Information
| Provider Information | |||||||||
| NPI: | 1336406313 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 SCOTT AVE | ||||||||
| Address2: | SUITE 27 | ||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763014671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9407619700 | ||||||||
| FaxNumber: | 9407619704 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 SCOTT AVE | ||||||||
| Address2: | SUITE 27 | ||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763014671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9407619700 | ||||||||
| FaxNumber: | 9407619704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2012 | ||||||||
| LastUpdateDate: | 04/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 36118 | TX | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.