Provider Demographics
NPI:1396808457
Name:ROBINSON, MERIELLE D (MC, LPC)
Entity type:Individual
Prefix:MRS
First Name:MERIELLE
Middle Name:D
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10366 E RAVENSWOOD ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5956
Mailing Address - Country:US
Mailing Address - Phone:520-907-4789
Mailing Address - Fax:
Practice Address - Street 1:2030 E BROADWAY BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5905
Practice Address - Country:US
Practice Address - Phone:520-907-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC2225101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor