Provider Demographics
NPI:1023376977
Name:ROBERTS, JOANNA LYN
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:LYN
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 1:6540 ARROW CREEK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-3714
Mailing Address - Country:US
Mailing Address - Phone:702-505-3756
Mailing Address - Fax:
Practice Address - Street 1:931 AZURE HEIGHTS PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-2890
Practice Address - Country:US
Practice Address - Phone:702-649-0649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-29
Last Update Date:2012-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health