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General NPI Number Information
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NPI Number | 1366263071
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Entity Type | Individual
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Provider Name | BROOKLYN NICOLE ROBERTSON LCSW, LAC
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Gender | Female
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 550 N CALIFORNIA ST
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City | MISSOULA
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State | MT
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Zip | 59802-3913
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Country | US
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Telephone | 406-868-4861
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 W KENT AVE UNIT 1246
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City | MISSOULA
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State | MT
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Zip | 59806-7049
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Country | US
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Telephone | 406-868-4861
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | BBH-LAC-LIC-70324
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | BBH-LCSW-LIC-72921
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License Number State | MT
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