Provider Demographics
NPI:1487868899
Name:ROBISON, WILLIAM A (PSYD, LP, LMFT)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:ROBISON
Suffix:
Gender:M
Credentials:PSYD, LP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4264
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:1350 E BRADFORD PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4376
Practice Address - Country:US
Practice Address - Phone:417-761-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007030433106H00000X, 106H00000X
MO2007028986103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007028986OtherSTATE COMMITTEE OF PSYCHOLOGY LICENSE NUMBER
MO494071301Medicaid
MO2007030433OtherSTATE COMMITTEE FOR MARRIAGE AND FAMILY THERAPIST LICENSE NUMBER
50373OtherNATIONAL REGISTER OF HEALTH SERVICE PROVIDERS IN PSYCHOLOGY