Provider Demographics
NPI:1871514919
Name:DEAKINS, ROBERT EDWARD (MA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:DEAKINS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W PHELPS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-4234
Mailing Address - Country:US
Mailing Address - Phone:417-619-5954
Mailing Address - Fax:
Practice Address - Street 1:1301 W PHELPS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-4234
Practice Address - Country:US
Practice Address - Phone:417-619-5954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVGOLDCARD390200000X
MO2003024989101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor