Provider Demographics
NPI:1194048926
Name:TODD, BOBBY JOE (LPC, LSOTP, LSSP,LCD)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:JOE
Last Name:TODD
Suffix:
Gender:M
Credentials:LPC, LSOTP, LSSP,LCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 COUNTY ROAD 484
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-7073
Mailing Address - Country:US
Mailing Address - Phone:254-965-6419
Mailing Address - Fax:
Practice Address - Street 1:1079 COUNTY ROAD 484
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-7073
Practice Address - Country:US
Practice Address - Phone:254-965-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94250101Y00000X
TX3590101YA0400X
TX12730101YM0800X
TX9710101YP2500X
TX6770103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool