Healthcare Provider Details

I. General information

NPI: 1205388485
Provider Name (Legal Business Name): TAHNEE RAE ROBERTS MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5245 CENTENNIAL BLVD STE 104
COLORADO SPRINGS CO
80919-4405
US

IV. Provider business mailing address

5245 CENTENNIAL BLVD STE 104
COLORADO SPRINGS CO
80919-4405
US

V. Phone/Fax

Practice location:
  • Phone: 719-368-9248
  • Fax:
Mailing address:
  • Phone: 719-368-9248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0017547
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0017547
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: