Provider Demographics
NPI:1770900011
Name:ROBINSON, GARY TODD (LMHC, LCAC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:TODD
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LMHC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 MEMORIAL DR STE 402
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1074
Mailing Address - Country:US
Mailing Address - Phone:574-400-4550
Mailing Address - Fax:574-400-4551
Practice Address - Street 1:621 MEMORIAL DR STE 402
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1074
Practice Address - Country:US
Practice Address - Phone:574-400-4550
Practice Address - Fax:574-400-4551
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000031A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health