Provider Demographics
NPI:1316705668
Name:ROBINSON, SHALETHA MILLER (LPC)
Entity type:Individual
Prefix:
First Name:SHALETHA
Middle Name:MILLER
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 WHITE PORCH AVE
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4055
Mailing Address - Country:US
Mailing Address - Phone:972-898-7947
Mailing Address - Fax:
Practice Address - Street 1:1026 WHITE PORCH AVE
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-4055
Practice Address - Country:US
Practice Address - Phone:972-898-7947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health