Provider Demographics
NPI:1548291370
Name:NORTH, ROBERT M SR (EDD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:NORTH
Suffix:SR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MAUPIN CIR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3781
Mailing Address - Country:US
Mailing Address - Phone:931-580-8936
Mailing Address - Fax:931-536-4346
Practice Address - Street 1:118 MAUPIN CIR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3781
Practice Address - Country:US
Practice Address - Phone:931-680-7576
Practice Address - Fax:931-536-4346
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000000878103TC0700X
KY1300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3683721Medicaid
TN3683728Medicaid
TN3683721Medicaid
TN3683728Medicare ID - Type Unspecified
TN3683728Medicaid