Provider Demographics
NPI:1952038531
Name:ROBINSON, KEYNICA M
Entity Type:Individual
Prefix:
First Name:KEYNICA
Middle Name:M
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
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 150
Mailing Address - Street 2:
Mailing Address - City:NESPELEM
Mailing Address - State:WA
Mailing Address - Zip Code:99155-0150
Mailing Address - Country:US
Mailing Address - Phone:509-634-2610
Mailing Address - Fax:509-634-2607
Practice Address - Street 1:11614 S HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:WA
Practice Address - Zip Code:99140-9537
Practice Address - Country:US
Practice Address - Phone:509-634-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDADT2576101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)