Healthcare Provider Details

I. General information

NPI: 1568707511
Provider Name (Legal Business Name): KASIA MCROBERTS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 CAMINO DE LOS MARQUEZ
SANTA FE NM
87505-1837
US

IV. Provider business mailing address

PO BOX 23804
SANTA FE NM
87502-3804
US

V. Phone/Fax

Practice location:
  • Phone: 505-316-4283
  • Fax:
Mailing address:
  • Phone: 505-316-4283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0166541
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: