Basic Information
| Provider Information | |||||||||
| NPI: | 1437395910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOHLI | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | HSPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 W KILGORE AVE | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473044810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652895437 | ||||||||
| FaxNumber: | 7652135094 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 W KILGORE AVE | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473044810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652895437 | ||||||||
| FaxNumber: | 7652135094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2009 | ||||||||
| LastUpdateDate: | 01/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TH0100X | 20041804A | IN | Y | Behavioral Health & Social Service Providers | Psychologist | Health Service |
ID Information
| ID | Type | State | Issuer | Description | 200888020 | 05 | IN | MEDICAID |