MEDICARE: W. RENEE ROBERTS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	35001766A	IN

General Provider Information

NPI Number	:	1265781470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	W. RENEE ROBERTS LMFT

Provider Business Mailing Address
First Line	:	2680 E MAIN ST
Second Line	:	SUITE 214
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2825
Country	:	US
Telephone Number	:	317-640-5946
Fax Number	:

Provider Business Practice Location Address
First Line	:	2680 E MAIN ST
Second Line	:	SUITE 214
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2825
Country	:	US
Telephone Number	:	317-640-5946
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2012
Last Update Date	:	03/21/2024

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