Provider Demographics
NPI:1407370695
Name:ROBERTS, MYRANDA LYNN (CDPT)
Entity Type:Individual
Prefix:
First Name:MYRANDA
Middle Name:LYNN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W 1ST ST APT 16B
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-8816
Mailing Address - Country:US
Mailing Address - Phone:253-548-5422
Mailing Address - Fax:
Practice Address - Street 1:230 GRANT RD STE A25
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-7722
Practice Address - Country:US
Practice Address - Phone:509-884-9040
Practice Address - Fax:509-884-9041
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)