Provider Demographics
NPI:1477709954
Name:KLEISLER, ROBIN ALYSE (MA, LPC, MAC, LAC)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:ALYSE
Last Name:KLEISLER
Suffix:
Gender:F
Credentials:MA, LPC, MAC, LAC
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:ALYSE
Other - Last Name:ARFA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, MAC, LCAS
Mailing Address - Street 1:4245 FLORENTINE DR.
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503
Mailing Address - Country:US
Mailing Address - Phone:828-545-6909
Mailing Address - Fax:
Practice Address - Street 1:1079 S HOVER ST STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7924
Practice Address - Country:US
Practice Address - Phone:720-534-1875
Practice Address - Fax:720-204-7266
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000368101YA0400X
CO0011463101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103968Medicaid