MEDICARE: KATHERINE ELYSE ROBERTS

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	.00022707	CO

General Provider Information

NPI Number	:	1821570813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ELYSE ROBERTS

Provider Business Mailing Address
First Line	:	7635 STORMY WAY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-2369
Country	:	US
Telephone Number	:	512-534-7073
Fax Number	:

Provider Business Practice Location Address
First Line	:	7025 TALL OAK DR STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2500
Country	:	US
Telephone Number	:	796-644-6215
Fax Number	:

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

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	02/16/2026

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