| Doctor Name: | ROBERT MATTHEW MINDRUP |
| NPI Number: | 1598098527 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSYD |
| License Number: | P2924 |
| Business Practice Address: | 4330 Maynardville Hwy Maynardville, TN - 378073618 |
| Business Phone Number: | 8659923849 |
| Business Fax Number: | 8659925166 |
| Mailing Address: | 6350 W A J Hwy, Department 100 TALBOTT |
| State: | TN |
| Postal Code: | 378778605 |
| Phone Number: | 8003553565 |
| Fax Number: | 4237142355 |
| NPI Enumeration Date: | 09/09/2009 |
| NPI Last Update Date: | 10/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | P2924 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |