Healthcare Provider Details

I. General information

NPI: 1003741687
Provider Name (Legal Business Name): MICHAEL ROBERTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 TOWNSHIP ROAD 349
IRONTON OH
45638-8617
US

IV. Provider business mailing address

81 TOWNSHIP ROAD 349
IRONTON OH
45638-8617
US

V. Phone/Fax

Practice location:
  • Phone: 740-442-7758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.193949
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: