MEDICARE: TAHNEE RAE ROBERTS MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC.0017547	CO
2	101YM0800X	Mental Health Counselor	LPC.0017547	CO

General Provider Information

NPI Number	:	1205388485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAHNEE RAE ROBERTS MS, LPC

Provider Business Mailing Address
First Line	:	5245 CENTENNIAL BLVD STE 104
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-4405
Country	:	US
Telephone Number	:	719-368-9248
Fax Number	:

Provider Business Practice Location Address
First Line	:	5245 CENTENNIAL BLVD STE 104
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-4405
Country	:	US
Telephone Number	:	719-368-9248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2016
Last Update Date	:	05/15/2024

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