Provider Demographics
NPI:1447506324
Name:ROBERTS, JESSIE NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:NICOLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials: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 171
Mailing Address - Street 2:
Mailing Address - City:BOSWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74707
Mailing Address - Country:US
Mailing Address - Phone:580-969-8713
Mailing Address - Fax:
Practice Address - Street 1:501 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-3809
Practice Address - Country:US
Practice Address - Phone:580-579-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health