Basic Information
| Provider Information | |||||||||
| NPI: | 1740358902 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GARY ROBINSON & ASSOCIATES LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | KENT PSYCHOLOGICAL ASSOCIATES,LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 CURRIE HALL PKWY | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442404312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306735812 | ||||||||
| FaxNumber: | 3306737162 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 CURRIE HALL PKWY | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442404312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306735812 | ||||||||
| FaxNumber: | 3306737162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 07/05/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MCCLURE | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3306735812 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PSY.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 103T00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 0102952 | 05 | OH | MEDICAID | 005334187364906 | 01 | CIGNA | OTHER | 2522603 | 05 | OH | MEDICAID | 774583000 | 01 | MAGELLAN | OTHER |