=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497730568
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAIL ROBERSON-FATINO LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2005
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1852 N COMMERCE DR
-----------------------------------------------------
City | NIXA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65714-7603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-850-4555
-----------------------------------------------------
Fax | 417-777-7017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 610A E BATTLEFIELD ST STE 113
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65807-4865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-850-4555
-----------------------------------------------------
Fax | 417-777-7017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 001811
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------