Healthcare Provider Details

I. General information

NPI: 1376233445
Provider Name (Legal Business Name): ELYSE ROBINSON MA, LPCC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14665 GALAXIE AVE STE 140
APPLE VALLEY MN
55124-4509
US

IV. Provider business mailing address

416 INTERLACHEN LN
BURNSVILLE MN
55306-6410
US

V. Phone/Fax

Practice location:
  • Phone: 651-456-8494
  • Fax:
Mailing address:
  • Phone: 515-669-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC04188
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305988
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: