Healthcare Provider Details

I. General information

NPI: 1407221088
Provider Name (Legal Business Name): LAUREN ROBBINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 GRAND AVE
SAINT PAUL MN
55105-3002
US

IV. Provider business mailing address

1061 GRAND AVE
SAINT PAUL MN
55105-3002
US

V. Phone/Fax

Practice location:
  • Phone: 651-212-4920
  • Fax:
Mailing address:
  • Phone: 651-212-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCC00995
License Number StateMN

VIII. Authorized Official

Name: LAUREN ROBBINS
Title or Position: OWNER
Credential:
Phone: 651-212-4920