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General NPI Number Information
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NPI Number | 1144494097
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Entity Type | Organization
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Legal Business Name | WALTER E. ROBERSON JR.
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 4507B LACLEDE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2103
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Country | US
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Telephone | 314-374-9797
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Fax |
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Provider Business Mailing Address
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Address Line | 2036 HONEY RIDGE CT
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City | CHESTERFIELD
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State | MO
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Zip | 63017-7602
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | WALTER E. ROBERSON
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Credential | LPC
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Telephone | 314-374-9797
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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 | 001977
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License Number State | MO
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