Provider Demographics
NPI:1033657432
Name:ROBERTSON, NORMAN
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:3322 STRAHAN PKWY
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-9162
Mailing Address - Country:US
Mailing Address - Phone:307-672-2044
Mailing Address - Fax:307-674-6867
Practice Address - Street 1:3322 STRAHAN PKWY
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-9162
Practice Address - Country:US
Practice Address - Phone:307-672-2044
Practice Address - Fax:307-674-6867
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC617101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional