Provider Demographics
NPI:1295385441
Name:ROBERTS, ELLEN (MSCP, LMFT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSCP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 VANCOUVER PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2454
Mailing Address - Country:US
Mailing Address - Phone:808-252-8252
Mailing Address - Fax:808-212-8252
Practice Address - Street 1:1808 VANCOUVER PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2454
Practice Address - Country:US
Practice Address - Phone:808-212-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
HIMFT-738101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health