Provider Demographics
NPI:1174266209
Name:ROBINSON, MERCEDES NICOLE
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:NICOLE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 SILVER SPUR WAY
Mailing Address - Street 2:
Mailing Address - City:PLUMAS LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95961-9112
Mailing Address - Country:US
Mailing Address - Phone:530-315-6833
Mailing Address - Fax:
Practice Address - Street 1:19 WILLIAMSBURG LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2225
Practice Address - Country:US
Practice Address - Phone:530-715-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
CA132608106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist