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General NPI Number Information
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NPI Number | 1558407478
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Entity Type | Individual
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Provider Name | CATHY RENEE' ROBERTSON LPC
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 9378 OLIVE BLVD SUITE 316
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City | OLIVETTE
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State | MO
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Zip | 63132-3215
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Country | US
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Telephone | 314-603-0149
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Fax |
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Provider Business Mailing Address
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Address Line | 7117 BLUE SPRUCE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63121-2702
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Country | US
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Telephone | 314-603-0149
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Fax | 314-385-7218
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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 | 2000175177
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2000175177
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2000175177
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License Number State | MO
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