Healthcare Provider Details

I. General information

NPI: 1376357772
Provider Name (Legal Business Name): MICHAEL ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 OLD CANOE CREEK RD
ST CLOUD FL
34769
US

IV. Provider business mailing address

4741 OLD CANOE CREEK RD
SAINT CLOUD FL
34769-1400
US

V. Phone/Fax

Practice location:
  • Phone: 407-715-2099
  • Fax:
Mailing address:
  • Phone: 407-715-2099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH26254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: