Provider Demographics
NPI:1386730166
Name:SNELLGROVE, ROBERT BRANTLEY (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRANTLEY
Last Name:SNELLGROVE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 MONTROSE BLVD
Mailing Address - Street 2:540
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006
Mailing Address - Country:US
Mailing Address - Phone:713-522-7014
Mailing Address - Fax:713-522-1196
Practice Address - Street 1:4200 MONTROSE BLVD
Practice Address - Street 2:540
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006
Practice Address - Country:US
Practice Address - Phone:713-522-7014
Practice Address - Fax:713-522-1196
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S20YMedicare ID - Type Unspecified