1528074879 NPI number — ROBIN LEE GANS LCSW

Table of content: ROBIN LEE GANS LCSW (NPI 1528074879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528074879 NPI number — ROBIN LEE GANS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANS
Provider First Name:
ROBIN
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEINHER GANS
Provider Other First Name:
ROBIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1528074879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9123 VICTORY PASS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78240-4027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-269-1130
Provider Business Mailing Address Fax Number:
210-403-2722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20079 STONE OAK PKWY
Provider Second Line Business Practice Location Address:
SUITE 1240
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-6942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-269-1130
Provider Business Practice Location Address Fax Number:
210-403-2722
Provider Enumeration Date:
07/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  33898 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 189056803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".