Doctor Name: | MR. ROBERT GLENN LACK |
NPI Number: | 1386877389 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA, CDP |
License Number: | RC-00018500 |
Business Practice Address: | 1010 E Bruneau Ave Kennewick, WA - 993363775 |
Business Phone Number: | 5097357410 |
Business Fax Number: | 5097835953 |
Mailing Address: | Po Box 5697, KENNEWICK |
State: | WA |
Postal Code: | 993360697 |
Phone Number: | 5097357410 |
Fax Number: | 5097835953 |
NPI Enumeration Date: | 08/25/2009 |
NPI Last Update Date: | 08/25/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | RC-00018500 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |