Healthcare Provider Details

I. General information

NPI: 1922564038
Provider Name (Legal Business Name): RYAN MATTHEW ROBINSON MA LPCC LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTHCROSS DR W
BURNSVILLE MN
55306-7012
US

IV. Provider business mailing address

1701 SOUTHCROSS DR W
BURNSVILLE MN
55306-7012
US

V. Phone/Fax

Practice location:
  • Phone: 952-232-5017
  • Fax:
Mailing address:
  • Phone: 952-232-5017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3093
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number304756
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: