Provider Demographics
NPI:1659040368
Name:ROBERSON, DANIEL RICHARD (LMHC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RICHARD
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15619 16TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8197
Mailing Address - Country:US
Mailing Address - Phone:303-902-0833
Mailing Address - Fax:
Practice Address - Street 1:102 E HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1517
Practice Address - Country:US
Practice Address - Phone:360-230-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61146876101YA0400X, 101YA0400X
WALH61526870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
16081494OtherCAQH
WA2189382Medicaid
WALH61526870OtherDOH - LICENSE