Provider Demographics
NPI:1568593713
Name:DOWNEY, ROBERTA FELICA (MFT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:FELICA
Last Name:DOWNEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:ANIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99557-0306
Mailing Address - Country:US
Mailing Address - Phone:907-675-4556
Mailing Address - Fax:907-675-4266
Practice Address - Street 1:269 MORGAN ROAD
Practice Address - Street 2:
Practice Address - City:ANIAK
Practice Address - State:AK
Practice Address - Zip Code:99557-0306
Practice Address - Country:US
Practice Address - Phone:907-675-4556
Practice Address - Fax:907-675-4266
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48237MFTI101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor