Provider Demographics
NPI:1366856353
Name:ROBERTSON, AMY (LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10118 TRACY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3346
Mailing Address - Country:US
Mailing Address - Phone:816-226-7298
Mailing Address - Fax:816-207-0543
Practice Address - Street 1:10118 TRACY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-3346
Practice Address - Country:US
Practice Address - Phone:816-226-7298
Practice Address - Fax:816-207-0543
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS02950101YP2500X
MO2013042531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional