MEDICARE: MRS. OCTAVIA R CHENAULT-ROBINSON MA, RLMHC,R/MFT,LLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	R11398	OR
2	101Y00000X	Counselor	MHCAMC61625623	WA
3	101YM0800X	Mental Health Counselor	IMH27042	FL
4	101YP2500X	Professional Counselor	6451023868	MI

General Provider Information

NPI Number	:	1225816572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OCTAVIA R CHENAULT-ROBINSON MA, RLMHC,R/MFT,LLPC

Provider Business Mailing Address
First Line	:	PO BOX 80774
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-5774
Country	:	US
Telephone Number	:	313-887-0087
Fax Number	:	313-887-4112

Provider Business Practice Location Address
First Line	:	100 N HOWARD ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0508
Country	:	US
Telephone Number	:	313-887-0087
Fax Number	:	313-887-4112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	01/19/2026

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