Provider Demographics
NPI:1497961056
Name:ROBERTS, STEVEN DALE (MED)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DALE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 CHINOOK LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:CO
Mailing Address - Zip Code:80816-8730
Mailing Address - Country:US
Mailing Address - Phone:719-689-6774
Mailing Address - Fax:719-471-0741
Practice Address - Street 1:420 N NEVADA AVE RM 138S
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1227
Practice Address - Country:US
Practice Address - Phone:719-471-2500
Practice Address - Fax:719-471-0741
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO470101YP2500X
CO219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist