Healthcare Provider Details

I. General information

NPI: 1568390326
Provider Name (Legal Business Name): ROBIN MELVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9531 W 78TH ST STE 220
EDEN PRAIRIE MN
55344-3863
US

IV. Provider business mailing address

4930 VALLEY FORGE LN N
MINNEAPOLIS MN
55442-3023
US

V. Phone/Fax

Practice location:
  • Phone: 952-395-3290
  • Fax:
Mailing address:
  • Phone: 507-271-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5602
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: