Active NPI
Gregory John Robertson, LADC
- Addiction (Substance Use Disorder) Counselor
- Saint Paul, MN
National Provider Identifier
1881230134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 300291
- Practice address
- 1380 Energy LN Ste 203
Saint Paul, MN 55108-5253 - Phone
- (651) 210-5287
- Fax
- (651) 212-4884
- NPI assigned
- Nov 21, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 300291 | MN | Primary |
Addresses
Primary practice location
1380 Energy LN Ste 203
Saint Paul, MN 55108-5253
Mailing address
6969 Valley Creek Road
220
Woodbury, MN 55125
Phone (651) 210-5287
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13465318094 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 300291 | MN | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574294400000",
"number": "1881230134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6969 VALLEY CREEK ROAD",
"address_2": "220",
"city": "WOODBURY",
"state": "MN",
"postal_code": "55125",
"telephone_number": "651-210-5287",
"fax_number": "651-212-4884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1380 ENERGY LN STE 203",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551085253",
"telephone_number": "651-210-5287",
"fax_number": "651-212-4884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "GREGORY",
"middle_name": "JOHN",
"credential": "LADC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-11-21",
"last_updated": "2019-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "300291",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "13465318094",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.