Healthcare Provider Details

I. General information

NPI: 1790602316
Provider Name (Legal Business Name): LACEEN MARIE ROBERTS CAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W ABRIENDO AVE
PUEBLO CO
81004-1870
US

IV. Provider business mailing address

275 W ABRIENDO AVE
PUEBLO CO
81004-1870
US

V. Phone/Fax

Practice location:
  • Phone: 719-621-1929
  • Fax:
Mailing address:
  • Phone: 719-621-1929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0008391
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: