Healthcare Provider Details

I. General information

NPI: 1417373960
Provider Name (Legal Business Name): MARY ROBERTS LPC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 BLANKENSHIP RD STE 120
WEST LINN OR
97068-5100
US

IV. Provider business mailing address

PO BOX 662
WEST LINN OR
97068-0662
US

V. Phone/Fax

Practice location:
  • Phone: 360-338-8286
  • Fax:
Mailing address:
  • Phone: 360-338-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC9489
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60537867
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: