Provider Demographics
NPI:1497066823
Name:ROBINSON, PHYL K (MFT)
Entity Type:Individual
Prefix:
First Name:PHYL
Middle Name:K
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11436 E LUPINE LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-7649
Mailing Address - Country:US
Mailing Address - Phone:951-515-3730
Mailing Address - Fax:520-723-9794
Practice Address - Street 1:11436 E LUPINE LN
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-7649
Practice Address - Country:US
Practice Address - Phone:951-515-3730
Practice Address - Fax:520-723-9794
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 14031106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist