| Doctor Name: | DR. ROBERT M THEODORE |
| NPI Number: | 1043487168 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 000776 |
| Business Practice Address: | 800 University Dr Maryville, MO - 644686015 |
| Business Phone Number: | 6605621056 |
| Business Fax Number: | |
| Mailing Address: | 800 University Dr, MARYVILLE |
| State: | MO |
| Postal Code: | 644686015 |
| Phone Number: | 6605621056 |
| Fax Number: | |
| NPI Enumeration Date: | 05/08/2008 |
| NPI Last Update Date: | 05/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 000776 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |