Provider Demographics
NPI:1861074569
Name:ROBBINS, LIBERTY AYNN (PPC)
Entity type:Individual
Prefix:
First Name:LIBERTY
Middle Name:AYNN
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3501
Mailing Address - Country:US
Mailing Address - Phone:307-264-4622
Mailing Address - Fax:
Practice Address - Street 1:623 W 20TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3501
Practice Address - Country:US
Practice Address - Phone:307-264-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY101YM0800X
WYLPC-1257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health