Provider Demographics
NPI:1659452068
Name:ROBERTSON, TOMMIE L (IMFT)
Entity Type:Individual
Prefix:
First Name:TOMMIE
Middle Name:L
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E GALBRAITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45216-1353
Mailing Address - Country:US
Mailing Address - Phone:513-948-0023
Mailing Address - Fax:513-948-0087
Practice Address - Street 1:203 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-1353
Practice Address - Country:US
Practice Address - Phone:513-948-0023
Practice Address - Fax:513-948-0087
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0700106H00000X
OHF.0900007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY184607OtherMEDICARE GROUP NUMBER