Provider Demographics
NPI:1538425350
Name:ROBINSON, KELLY ANN (MFT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 PETALUMA AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4206
Mailing Address - Country:US
Mailing Address - Phone:707-869-0654
Mailing Address - Fax:707-823-1642
Practice Address - Street 1:477 PETALUMA AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4206
Practice Address - Country:US
Practice Address - Phone:707-869-0654
Practice Address - Fax:707-823-1642
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51114106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist