Provider Demographics
NPI:1215424585
Name:ROBINSON, PATRICK STEPHEN (LMFT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:STEPHEN
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:JUNG SOO
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:489 LEEWARD TRL
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-9494
Mailing Address - Country:US
Mailing Address - Phone:612-251-1575
Mailing Address - Fax:
Practice Address - Street 1:1405 LILAC DR N STE 150
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4536
Practice Address - Country:US
Practice Address - Phone:612-280-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-21
Last Update Date:2018-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist