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General NPI Number Information
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NPI Number | 1043057219
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Entity Type | Individual
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Provider Name | KYRA ROBERTS LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 07/13/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 3351 CLAYSTONE ST SE STE G32
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-5794
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Country | US
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Telephone | 352-238-1608
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Fax |
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Provider Business Mailing Address
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Address Line | 51771 PLEASANT DR
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City | MATTAWAN
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State | MI
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Zip | 49071
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Country | US
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Telephone | 352-238-1608
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451023959
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License Number State | MI
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