Provider Demographics
NPI:1033964929
Name:KAETLYN ROBERTS COUNSELING SERVICES
Entity Type:Organization
Organization Name:KAETLYN ROBERTS COUNSELING SERVICES
Other - Org Name:KAETLYN MCKEE ROBERTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAETLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEE ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-723-1219
Mailing Address - Street 1:324 COMANCHE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-9319
Mailing Address - Country:US
Mailing Address - Phone:573-723-1219
Mailing Address - Fax:573-562-6121
Practice Address - Street 1:5896 OSAGE BEACH PKWY STE 3
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3040
Practice Address - Country:US
Practice Address - Phone:573-723-1219
Practice Address - Fax:573-562-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty