Provider Demographics
NPI:1942962642
Name:ROBINSON, DAVID RUSSELL
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RUSSELL
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 1:9801 SAINT JOHNS RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-4638
Mailing Address - Country:US
Mailing Address - Phone:541-292-4714
Mailing Address - Fax:
Practice Address - Street 1:9801 SAINT JOHNS RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-4638
Practice Address - Country:US
Practice Address - Phone:541-292-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional