Provider Demographics
NPI:1659410595
Name:ROBINSON, MICHAEL CLARENCE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CLARENCE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 51275
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84605-1275
Mailing Address - Country:US
Mailing Address - Phone:801-222-0603
Mailing Address - Fax:801-222-0218
Practice Address - Street 1:124 NORTH OREM BOULEVARD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057
Practice Address - Country:US
Practice Address - Phone:801-222-0603
Practice Address - Fax:801-222-0218
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140551-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health