Provider Demographics
NPI:1174649339
Name:BURCH, ROBERT FRANK (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANK
Last Name:BURCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NW PARK PL
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2954
Mailing Address - Country:US
Mailing Address - Phone:541-388-9271
Mailing Address - Fax:
Practice Address - Street 1:1011 SW EMKAY DR STE 101
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3162
Practice Address - Country:US
Practice Address - Phone:541-388-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1710103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical