Provider Demographics
NPI:1720569916
Name:ROBERTS, AMBER LYNN (LMHC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 S PACHECO ST APT A9
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5425
Mailing Address - Country:US
Mailing Address - Phone:806-338-0294
Mailing Address - Fax:
Practice Address - Street 1:5020 SAN PEDRO CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2515
Practice Address - Country:US
Practice Address - Phone:931-650-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health