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General NPI Number Information
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NPI Number | 1780090407
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Entity Type | Individual
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Provider Name | MICHELLE A ROBERTSON M.A.
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Gender | Female
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 190 OVERTHRUST RD.
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City | EVANSTON
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State | WY
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Zip | 82930-2910
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Country | US
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Telephone | 307-789-4224
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2910 190 OVERTHRUST RD
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City | EVANSTON
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State | WY
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Zip | 82931-2910
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Country | US
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Telephone | 307-885-3823
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Fax | 307-885-5206
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-1555
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PPC-847
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PPC-847
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License Number State | WY
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