Provider Demographics
NPI:1467123869
Name:ROBERTS, JOHN LEE (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LEE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 LOCHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7551
Mailing Address - Country:US
Mailing Address - Phone:501-214-5424
Mailing Address - Fax:501-984-8611
Practice Address - Street 1:628 W BROADWAY ST STE 300
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-5547
Practice Address - Country:US
Practice Address - Phone:501-214-5424
Practice Address - Fax:501-984-8611
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2210011101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP2210011OtherLPC
1417089558OtherNPI PROVIDER NUMBER