Provider Demographics
NPI:1124553565
Name:ROBERTS, HEATHER JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JEAN
Last Name:ROBERTS
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 1:1463 LEGENDS CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5813
Mailing Address - Country:US
Mailing Address - Phone:316-461-4860
Mailing Address - Fax:
Practice Address - Street 1:11090 183RD CIR NW STE C
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2884
Practice Address - Country:US
Practice Address - Phone:763-333-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3000101YM0800X
MN2437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health