MEDICARE: AMBER ROBERTS MS PLPC/CRADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	6479	MO
2	101YM0800X	Mental Health Counselor	2015043574	MO

General Provider Information

NPI Number	:	1871045252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER ROBERTS MS PLPC/CRADC

Provider Business Mailing Address
First Line	:	12677 HEAVENLY ACRES DR
Second Line	:
City	:	NEW LONDON
State	:	MO
Zip	:	63459-2436
Country	:	US
Telephone Number	:	573-248-1372
Fax Number	:	573-248-1375

Provider Business Practice Location Address
First Line	:	12677 HEAVENLY ACRES DR
Second Line	:
City	:	NEW LONDON
State	:	MO
Zip	:	63459-2436
Country	:	US
Telephone Number	:	573-248-1372
Fax Number	:	573-248-1375

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

Provider Enumeration Date	:	11/01/2016
Last Update Date	:	11/01/2016

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