Provider Demographics
NPI:1497730568
Name:ROBERSON, GAIL (LPC)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E 7TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2226
Mailing Address - Country:US
Mailing Address - Phone:417-781-4552
Mailing Address - Fax:417-782-1844
Practice Address - Street 1:410 E 7TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2226
Practice Address - Country:US
Practice Address - Phone:417-781-4552
Practice Address - Fax:417-782-1844
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional