Provider Demographics
NPI:1871045252
Name:ROBERTS, AMBER (MS PLPC/CRADC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS PLPC/CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12677 HEAVENLY ACRES DR
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:MO
Mailing Address - Zip Code:63459-2436
Mailing Address - Country:US
Mailing Address - Phone:573-248-1372
Mailing Address - Fax:573-248-1375
Practice Address - Street 1:12677 HEAVENLY ACRES DR
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:MO
Practice Address - Zip Code:63459-2436
Practice Address - Country:US
Practice Address - Phone:573-248-1372
Practice Address - Fax:573-248-1375
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6479101YA0400X
MO2015043574101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)