Provider Demographics
NPI:1063654820
Name:ROBERTSON, JEANETTE MICHELLE (PHD, LCMFT)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:MICHELLE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PHD, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W UNIVERSITY AVE
Mailing Address - Street 2:MARRIAGE AND FAMILY THERAPY
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-3379
Mailing Address - Country:US
Mailing Address - Phone:316-295-5609
Mailing Address - Fax:316-295-5115
Practice Address - Street 1:2100 W UNIVERSITY AVE
Practice Address - Street 2:MARRIAGE AND FAMILY THERAPY
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-3379
Practice Address - Country:US
Practice Address - Phone:316-295-5609
Practice Address - Fax:316-295-5115
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS303106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist