Healthcare Provider Details

I. General information

NPI: 1063601979
Provider Name (Legal Business Name): GINA MARIE ROBINSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 WYOMING ST
KANSAS CITY MO
64111-3945
US

IV. Provider business mailing address

4820 W 68TH ST
PRAIRIE VILLAGE KS
66208-1439
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-6700
  • Fax:
Mailing address:
  • Phone: 913-677-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2004034170
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: