MEDICARE: LAURA ROBINSON LMHC

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	101YM0800X	Mental Health Counselor	39000976A	IN

General Provider Information

NPI Number	:	1598298879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ROBINSON LMHC

Provider Business Mailing Address
First Line	:	4103 ABOITE LAKE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-3911
Country	:	US
Telephone Number	:	260-414-3989
Fax Number	:

Provider Business Practice Location Address
First Line	:	4103 ABOITE LAKE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-3911
Country	:	US
Telephone Number	:	260-414-3989
Fax Number	:

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

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/04/2017

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