MEDICARE: LACRETIA ROBERTS LMFTA

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	99122545A	IN

General Provider Information

NPI Number	:	1548031354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACRETIA ROBERTS LMFTA

Provider Business Mailing Address
First Line	:	5625 N GERMAN CHURCH RD UNIT 2107
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-8513
Country	:	US
Telephone Number	:	305-771-5880
Fax Number	:

Provider Business Practice Location Address
First Line	:	5625 N GERMAN CHURCH RD UNIT 2107
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-8513
Country	:	US
Telephone Number	:	305-771-5880
Fax Number	:

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

Provider Enumeration Date	:	01/10/2024
Last Update Date	:	01/17/2024

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