Basic Information
| Provider Information | |||||||||
| NPI: | 1104127778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | GENE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MA, TLLP, LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10245 FELCH AVE | ||||||||
| Address2: | |||||||||
| City: | GRANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493278560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318340215 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12 W WOOD | ||||||||
| Address2: | |||||||||
| City: | NEWAYGO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316521780 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2010 | ||||||||
| LastUpdateDate: | 11/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401012113 | MI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 103TC0700X | 6301014524 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.