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NPI Code Detail

MEDICARE: LILY THERESE ROBERTSON

MEDICARE:   LILY THERESE 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
1106H00000XMarriage & Family Therapist390200000XMI

General Provider Information

NPI Number : 1982544219
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILY THERESE ROBERTSON
Provider Business Mailing Address
First Line : 5958 N CANTON CENTER RD STE 900
Second Line :
City : CANTON
State : MI
Zip : 48187-2740
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5958 N CANTON CENTER RD STE 900
Second Line :
City : CANTON
State : MI
Zip : 48187-2740
Country : US
Telephone Number : 734-737-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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Directions to “ LILY THERESE ROBERTSON ” Practice Location

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