Provider Demographics
NPI:1285774422
Name:BARRIS, ROBIN RENAE (TLLP, MA)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:RENAE
Last Name:BARRIS
Suffix:
Gender:F
Credentials:TLLP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 GLADE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-2778
Mailing Address - Country:US
Mailing Address - Phone:231-737-1213
Mailing Address - Fax:231-737-1218
Practice Address - Street 1:3370 GLADE STREET
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-2278
Practice Address - Country:US
Practice Address - Phone:231-737-1213
Practice Address - Fax:231-737-1218
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009658103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP108978420OtherBCBS
MI11659660OtherCAQH