Provider Demographics
NPI:1043931785
Name:PRESTON, ROBERT EDWIN (PHD, MA, MAOB)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWIN
Last Name:PRESTON
Suffix:
Gender:M
Credentials:PHD, MA, MAOB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 W SHAW AVE # 595
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-6210
Mailing Address - Country:US
Mailing Address - Phone:559-277-3405
Mailing Address - Fax:559-271-8927
Practice Address - Street 1:114 S BRAWLEY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2103
Practice Address - Country:US
Practice Address - Phone:559-277-3405
Practice Address - Fax:559-271-8927
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor