Healthcare Provider Details

I. General information

NPI: 1497086565
Provider Name (Legal Business Name): LAVELL TERAN ROBINSON MASTERS OF SCIENCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3467 W SHAW AVE STE 101
FRESNO CA
93711-3223
US

IV. Provider business mailing address

801 E ADELAIDE WAY
DINUBA CA
93618-1758
US

V. Phone/Fax

Practice location:
  • Phone: 559-271-3096
  • Fax: 559-274-0292
Mailing address:
  • Phone: 559-591-6800
  • Fax: 559-591-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: