Healthcare Provider Details

I. General information

NPI: 1659410595
Provider Name (Legal Business Name): MICHAEL CLARENCE ROBINSON M.S., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 NORTH OREM BOULEVARD
OREM UT
84057
US

IV. Provider business mailing address

P. O. BOX 51275
PROVO UT
84605-1275
US

V. Phone/Fax

Practice location:
  • Phone: 801-222-0603
  • Fax: 801-222-0218
Mailing address:
  • Phone: 801-222-0603
  • Fax: 801-222-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number140551-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: