Healthcare Provider Details

I. General information

NPI: 1942962642
Provider Name (Legal Business Name): DAVID RUSSELL ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 BELLE AVE
MANKATO MN
56001-5250
US

IV. Provider business mailing address

304 BELLE AVE
MANKATO MN
56001-5250
US

V. Phone/Fax

Practice location:
  • Phone: 877-909-5511
  • Fax: 507-888-0001
Mailing address:
  • Phone: 877-909-5511
  • Fax: 507-888-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3031
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: