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NPI Code Detail

MEDICARE: JESSICA ELLEN ROBERTSON M.S., LMFT

MEDICARE: JESSICA ELLEN ROBERTSON M.S., 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
1106H00000XMarriage & Family TherapistT0437MS
2101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447340161
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ELLEN ROBERTSON M.S., LMFT
Provider Business Mailing Address
First Line : 2130 GOVERNMENT ST STE A
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-3937
Country : US
Telephone Number : 228-382-3107
Fax Number : 800-854-0906
Provider Business Practice Location Address
First Line : 2130 GOVERNMENT ST STE A
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-3937
Country : US
Telephone Number : 228-382-3107
Fax Number : 800-854-0906
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 05/09/2019

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