Provider Demographics
NPI:1780892489
Name:ROBINSON, MARK LEE (D MIN)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:D MIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6454 ALAMO AVE
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3155
Mailing Address - Country:US
Mailing Address - Phone:314-863-2363
Mailing Address - Fax:314-727-4068
Practice Address - Street 1:6454 ALAMO AVE
Practice Address - Street 2:SUITE 2E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3155
Practice Address - Country:US
Practice Address - Phone:314-863-2363
Practice Address - Fax:314-727-4068
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
3889OtherAAPC #