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NPI Code Detail

MEDICARE: MICAH LEIGH ROBERTSON

MEDICARE: MICAH LEIGH ROBERTSON
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
1101YM0800XMental Health CounselorWA

General Provider Information

NPI Number : 1295005544
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICAH LEIGH ROBERTSON
Provider Business Mailing Address
First Line : 3600 MERIDIAN ST
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-1732
Country : US
Telephone Number : 360-676-6000
Fax Number :
Provider Business Practice Location Address
First Line : 3600 MERIDIAN ST
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-1732
Country : US
Telephone Number : 360-676-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2012
Last Update Date : 09/10/2025

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