Provider Demographics
NPI:1851990048
Name:ROBINSON, STANLEY (CRADC)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65615-0826
Mailing Address - Country:US
Mailing Address - Phone:417-527-8877
Mailing Address - Fax:833-496-0823
Practice Address - Street 1:895 STATE HIGHWAY 248 STE C
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-4013
Practice Address - Country:US
Practice Address - Phone:417-527-8877
Practice Address - Fax:833-496-0823
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO8346101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)