Provider Demographics
NPI:1447035365
Name:ROOF, ROBERT ANSLEY IV (MA LPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANSLEY
Last Name:ROOF
Suffix:IV
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:CO
Mailing Address - Zip Code:81433-0333
Mailing Address - Country:US
Mailing Address - Phone:970-749-5401
Mailing Address - Fax:
Practice Address - Street 1:1315 SNOWDEN ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:CO
Practice Address - Zip Code:81433-5108
Practice Address - Country:US
Practice Address - Phone:970-749-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019486101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional