Provider Demographics
NPI:1891178109
Name:ROBERTS, ANTHONY BERNARD (LPCC, LCADC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BERNARD
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LPCC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E EVELYN AVE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-1210
Mailing Address - Country:US
Mailing Address - Phone:606-348-0440
Mailing Address - Fax:606-348-0440
Practice Address - Street 1:126 E EVELYN AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-1210
Practice Address - Country:US
Practice Address - Phone:606-348-0440
Practice Address - Fax:606-348-0440
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY164870101YA0400X
KY166605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100374120Medicaid