Provider Demographics
NPI:1497086565
Name:ROBINSON, LAVELL TERAN (MASTERS OF SCIENCE)
Entity Type:Individual
Prefix:MR
First Name:LAVELL
Middle Name:TERAN
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MASTERS OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E ADELAIDE WAY
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-1758
Mailing Address - Country:US
Mailing Address - Phone:559-591-6800
Mailing Address - Fax:559-591-6800
Practice Address - Street 1:3467 W SHAW AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3223
Practice Address - Country:US
Practice Address - Phone:559-271-3096
Practice Address - Fax:559-274-0292
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YP1600X, 101YM0800X, 101YA0400X
WI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497086565Medicaid