Provider Demographics
NPI:1598487506
Name:ROBERTSON, MICHAEL LYNN (PCLC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LYNN
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 MORNINGSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-1174
Mailing Address - Country:US
Mailing Address - Phone:406-468-8446
Mailing Address - Fax:
Practice Address - Street 1:4208 MORNINGSIDE CIR
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-1174
Practice Address - Country:US
Practice Address - Phone:406-468-8446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-57381101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional