Provider Demographics
NPI:1679761407
Name:ROBINSON, DALE HOWARD SR (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:HOWARD
Last Name:ROBINSON
Suffix:SR
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N WESTWOOD BLVD
Mailing Address - Street 2:STE 8
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2800
Mailing Address - Country:US
Mailing Address - Phone:573-776-6767
Mailing Address - Fax:573-776-9691
Practice Address - Street 1:1901 N WESTWOOD BLVD
Practice Address - Street 2:STE 8
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2800
Practice Address - Country:US
Practice Address - Phone:573-776-6767
Practice Address - Fax:573-776-9691
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001929101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional