MEDICARE: ROBERTA IRENE PERNO 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	101YM0800X	Mental Health Counselor	LPC...0006109	CO

General Provider Information

NPI Number	:	1760618086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA IRENE PERNO LPC

Provider Business Mailing Address
First Line	:	1855 PRESIDENTIAL HTS APT 1026
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-8321
Country	:	US
Telephone Number	:	417-496-3452
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 PRESIDENTIAL HTS APT 1026
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-8321
Country	:	US
Telephone Number	:	417-496-3452
Fax Number	:

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

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	10/26/2024

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