Healthcare Provider Details

I. General information

NPI: 1558407478
Provider Name (Legal Business Name): CATHY RENEE' ROBERTSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9378 OLIVE BLVD SUITE 316
OLIVETTE MO
63132-3215
US

IV. Provider business mailing address

7117 BLUE SPRUCE DR
SAINT LOUIS MO
63121-2702
US

V. Phone/Fax

Practice location:
  • Phone: 314-603-0149
  • Fax:
Mailing address:
  • Phone: 314-603-0149
  • Fax: 314-385-7218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2000175177
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2000175177
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2000175177
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: