=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144373630
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY CHRISTINE ROBERTSON-HARPER LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4960 COLLESIUM DR
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33463-7248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-964-0266
-----------------------------------------------------
Fax | 561-969-6907
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4960 COLLESIUM DR
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33463-7248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-964-0266
-----------------------------------------------------
Fax | 561-969-6907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH 7487
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------