Provider Demographics
NPI:1235605312
Name:ROBERTS, MICHELLE C (CP60479268)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:C
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CP60479268
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2875
Mailing Address - Country:US
Mailing Address - Phone:509-853-4105
Mailing Address - Fax:509-853-0757
Practice Address - Street 1:120 S 3RD ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2875
Practice Address - Country:US
Practice Address - Phone:509-853-4105
Practice Address - Fax:509-853-0757
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60479268101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)