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General NPI Number Information
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NPI Number | 1912252008
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Entity Type | Individual
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Provider Name | CAROL CONSTANCE ROBERTS LCPC
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Gender | Female
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 1800 S 3RD ST W
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City | MISSOULA
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State | MT
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Zip | 59801-2244
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Country | US
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Telephone | 406-210-3512
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Fax |
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Provider Business Mailing Address
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Address Line | 516 SWEENEY CREEK LOOP
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City | FLORENCE
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State | MT
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Zip | 59833-6712
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Country | US
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Telephone | 406-210-3512
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Fax | 406-543-6777
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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 | 2161
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License Number State | MT
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