Provider Demographics
NPI:1689765125
Name:SHUPE, ROBERT K (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:K
Last Name:SHUPE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-4221
Mailing Address - Country:US
Mailing Address - Phone:903-704-8589
Mailing Address - Fax:903-722-2624
Practice Address - Street 1:1103 WILSON ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-6077
Practice Address - Country:US
Practice Address - Phone:903-655-0123
Practice Address - Fax:903-722-2624
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16000101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123757OtherCHIP
TX840006OtherBLUE CROSS BLUE SHIELD
TX163211901Medicaid