MEDICARE: JOHN LEE ROBERTS 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	P2210011	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2210011	OTHER	AR	LPC
2	1417089558	OTHER		NPI PROVIDER NUMBER

General Provider Information

NPI Number	:	1467123869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN LEE ROBERTS LPC

Provider Business Mailing Address
First Line	:	5015 LOCHRIDGE RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7551
Country	:	US
Telephone Number	:	501-214-5424
Fax Number	:	501-984-8611

Provider Business Practice Location Address
First Line	:	628 W BROADWAY ST STE 300
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-5547
Country	:	US
Telephone Number	:	501-214-5424
Fax Number	:	501-984-8611

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

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	03/04/2026

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