Provider Demographics
NPI:1932205283
Name:VINCENT, ROBERT LAURENCE (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LAURENCE
Last Name:VINCENT
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-0140
Mailing Address - Country:US
Mailing Address - Phone:253-770-1693
Mailing Address - Fax:253-770-4990
Practice Address - Street 1:12515 MERIDIAN E STE 204
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3436
Practice Address - Country:US
Practice Address - Phone:253-770-1693
Practice Address - Fax:253-770-4990
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1253106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist