Provider Demographics
NPI:1407068968
Name:ROBISON, MICHELE ALICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ALICE
Last Name:ROBISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27285 LAS RAMBLAS
Mailing Address - Street 2:SUITE 232
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6325
Mailing Address - Country:US
Mailing Address - Phone:949-460-2956
Mailing Address - Fax:949-582-3389
Practice Address - Street 1:27285 LAS RAMBLAS
Practice Address - Street 2:SUITE 232
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6325
Practice Address - Country:US
Practice Address - Phone:949-460-2956
Practice Address - Fax:949-582-3389
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13997103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR25406Medicare UPIN
CACP13997Medicare ID - Type Unspecified