Provider Demographics
NPI:1043831324
Name:ROBINSON, NATHEO
Entity type:Individual
Prefix:
First Name:NATHEO
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3174
Mailing Address - Country:US
Mailing Address - Phone:816-510-0117
Mailing Address - Fax:913-967-3535
Practice Address - Street 1:2101 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3174
Practice Address - Country:US
Practice Address - Phone:816-510-0117
Practice Address - Fax:913-967-3535
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORBT-21-158878106S00000X
KS103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSLBA00790OtherBEHAVIOR ANALYST