Provider Demographics
NPI:1750278719
Name:ROBINSON, JALEN THOMAS
Entity type:Individual
Prefix:
First Name:JALEN
Middle Name:THOMAS
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2863 PINE KNOLL DR APT 200D
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4229
Mailing Address - Country:US
Mailing Address - Phone:313-718-7823
Mailing Address - Fax:
Practice Address - Street 1:2863 PINE KNOLL DR APT 200D
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4229
Practice Address - Country:US
Practice Address - Phone:313-718-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst