Provider Demographics
NPI:1053463638
Name:ROBERSON, WALTER EUGENE JR (MA,LPC)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:EUGENE
Last Name:ROBERSON
Suffix:JR
Gender:M
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 HONEY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7602
Mailing Address - Country:US
Mailing Address - Phone:314-361-4673
Mailing Address - Fax:314-361-6649
Practice Address - Street 1:4507B LACLEDE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2103
Practice Address - Country:US
Practice Address - Phone:314-361-4673
Practice Address - Fax:314-361-6649
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health