Provider Demographics
NPI:1417464579
Name:ROBERSON, CATANNA L (MSED)
Entity Type:Individual
Prefix:MRS
First Name:CATANNA
Middle Name:L
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 COVENTRY LN STE 179
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7145
Mailing Address - Country:US
Mailing Address - Phone:260-207-4241
Mailing Address - Fax:
Practice Address - Street 1:4646 W JEFFERSON BLVD STE 270
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6832
Practice Address - Country:US
Practice Address - Phone:260-207-4241
Practice Address - Fax:260-201-9557
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN35002079A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health