Provider Demographics
NPI:1538290986
Name:ROBERTSON, SHIRLEY RUTH (MA, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:RUTH
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 HIGHWAY WW
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-9589
Mailing Address - Country:US
Mailing Address - Phone:660-886-2253
Mailing Address - Fax:660-886-6601
Practice Address - Street 1:1180 HIGHWAY WW
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-9589
Practice Address - Country:US
Practice Address - Phone:660-886-2253
Practice Address - Fax:660-886-6601
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS002072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional