Provider Demographics
NPI:1295275287
Name:FROST, ROBERT (MA, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:FROST
Suffix:
Gender:M
Credentials:MA, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 GLEASON LAKE RD APT 102
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1346
Mailing Address - Country:US
Mailing Address - Phone:952-288-8192
Mailing Address - Fax:
Practice Address - Street 1:155 GLEASON LAKE RD APT 102
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1346
Practice Address - Country:US
Practice Address - Phone:952-288-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health