Provider Demographics
NPI:1194298521
Name:ROBINSON, AMANDA (MED)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 E WAGNER RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3135
Mailing Address - Country:US
Mailing Address - Phone:405-514-2448
Mailing Address - Fax:
Practice Address - Street 1:6801 S WESTERN AVE STE 203&205
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1817
Practice Address - Country:US
Practice Address - Phone:405-514-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor