Healthcare Provider Details

I. General information

NPI: 1891368908
Provider Name (Legal Business Name): SIENNA ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 VISTA CIR
ARROYO GRANDE CA
93420-1619
US

IV. Provider business mailing address

119 VISTA CIR
ARROYO GRANDE CA
93420-1619
US

V. Phone/Fax

Practice location:
  • Phone: 805-710-2163
  • Fax:
Mailing address:
  • Phone: 805-710-2163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number118887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: