Provider Demographics
NPI:1093020943
Name:ROBERTSON, ELLA L (LPC)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:L
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 E 49TH ST
Mailing Address - Street 2:STE. 700
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-8710
Mailing Address - Country:US
Mailing Address - Phone:918-973-0434
Mailing Address - Fax:918-578-0037
Practice Address - Street 1:2202 E 49TH ST
Practice Address - Street 2:STE. 700
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-8710
Practice Address - Country:US
Practice Address - Phone:918-973-0434
Practice Address - Fax:918-578-0037
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health