Provider Demographics
NPI:1215658489
Name:PUMMILL, ROBYN LYNN
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:LYNN
Last Name:PUMMILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 QUICK SAND CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3776
Mailing Address - Country:US
Mailing Address - Phone:573-823-4765
Mailing Address - Fax:
Practice Address - Street 1:801 QUICK SAND CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3776
Practice Address - Country:US
Practice Address - Phone:573-823-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO$$$$$$$$$103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool