Provider Demographics
NPI:1679305296
Name:ROBERTS, MICHELLE CHRISTINE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 SW CORTEZ ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68523-7216
Mailing Address - Country:US
Mailing Address - Phone:720-243-1800
Mailing Address - Fax:
Practice Address - Street 1:5539 S 27TH ST STE 204
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1600
Practice Address - Country:US
Practice Address - Phone:402-435-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health