Provider Demographics
NPI:1528424116
Name:FANKELL, ROBIN M (MA)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:FANKELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:M
Other - Last Name:MCGILLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1636 SHOREVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80550-2880
Mailing Address - Country:US
Mailing Address - Phone:720-254-0389
Mailing Address - Fax:
Practice Address - Street 1:4689 W 20TH ST STE E-8
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3218
Practice Address - Country:US
Practice Address - Phone:720-254-0389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
COLPC.0014088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor