Provider Demographics
NPI:1871716209
Name:ROBERTSON, REBECCA (MS LPC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LPC
Mailing Address - Street 1:1320 S COMMERCE ST TRLR 88
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5506
Mailing Address - Country:US
Mailing Address - Phone:580-371-8438
Mailing Address - Fax:580-795-7444
Practice Address - Street 1:105 PLAZA
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-2248
Practice Address - Country:US
Practice Address - Phone:580-795-7439
Practice Address - Fax:580-795-7444
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2521101YP2500X
TX14789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional