Healthcare Provider Details

I. General information

NPI: 1144075250
Provider Name (Legal Business Name): ROBERT MACINNES LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARSCHALL RD STE 100
SHAKOPEE MN
55379-2689
US

IV. Provider business mailing address

500 MARSCHALL RD STE 300
SHAKOPEE MN
55379-2690
US

V. Phone/Fax

Practice location:
  • Phone: 952-448-6557
  • Fax: 952-448-6047
Mailing address:
  • Phone: 952-448-6557
  • Fax: 952-448-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: