Provider Demographics
NPI:1346900156
Name:HOOD, ROBERTA LYNN (MA)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:LYNN
Last Name:HOOD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:LYNN
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-1240
Mailing Address - Country:US
Mailing Address - Phone:530-921-7715
Mailing Address - Fax:
Practice Address - Street 1:1420 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-1240
Practice Address - Country:US
Practice Address - Phone:530-921-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT129439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health