Provider Demographics
NPI:1568774842
Name:ROBERTS, JOHN L (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 N CLASSEN BLVD
Mailing Address - Street 2:SUITE C110
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2862
Mailing Address - Country:US
Mailing Address - Phone:405-613-5230
Mailing Address - Fax:405-525-0530
Practice Address - Street 1:3800 N CLASSEN BLVD
Practice Address - Street 2:SUITE C110
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2862
Practice Address - Country:US
Practice Address - Phone:405-613-5230
Practice Address - Fax:405-525-0530
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2060101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health