Provider Demographics
NPI:1578231346
Name:ROBERSON, KIETHA M (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KIETHA
Middle Name:M
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 WOODCREEK GLEN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-3133
Mailing Address - Country:US
Mailing Address - Phone:832-375-4163
Mailing Address - Fax:
Practice Address - Street 1:3506 WOODCREEK GLEN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-3133
Practice Address - Country:US
Practice Address - Phone:832-375-4163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-05
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX07474640OtherINSURANCE