Provider Demographics
NPI:1760851588
Name:ROBERTS, BRUCE (MA, QMHP)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 CHRISTIE DRIVE
Mailing Address - Street 2:CHRISTIE CAMPUS
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-1328
Mailing Address - Country:US
Mailing Address - Phone:503-635-3416
Mailing Address - Fax:
Practice Address - Street 1:2507 CHRISTIE DRIVE
Practice Address - Street 2:CHRISTIE CAMPUS
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034
Practice Address - Country:US
Practice Address - Phone:503-635-3416
Practice Address - Fax:503-675-2258
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health