Provider Demographics
NPI:1740915917
Name:ROBERTS, MCKAYLA ALEXANDRIA
Entity type:Individual
Prefix:MS
First Name:MCKAYLA
Middle Name:ALEXANDRIA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 VALDEZ ST APT 227
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3193
Mailing Address - Country:US
Mailing Address - Phone:402-671-2836
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST STE 542
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2945
Practice Address - Country:US
Practice Address - Phone:402-401-4445
Practice Address - Fax:402-702-0583
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health