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General NPI Number Information
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NPI Number | 1790142420
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Entity Type | Individual
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Provider Name | MICHELLE ROBERTS
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Gender | Female
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 1115 BADGER CIRCLE
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City | VENTURA
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State | CA
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Zip | 93003
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Country | US
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Telephone | 805-509-6283
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Fax |
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Provider Business Mailing Address
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Address Line | 3606 N RANCHO DR STE 102
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City | LAS VEGAS
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State | NV
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Zip | 89130-3196
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Country | US
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Telephone | 805-509-6283
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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