Provider Demographics
NPI:1760618086
Name:PERNO, ROBERTA IRENE (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:IRENE
Last Name:PERNO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 N CRESTHAVEN AVE APT B401
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-7828
Mailing Address - Country:US
Mailing Address - Phone:417-496-3452
Mailing Address - Fax:
Practice Address - Street 1:2601 N CRESTHAVEN AVE APT B401
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-7828
Practice Address - Country:US
Practice Address - Phone:417-496-3452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001031959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health