Provider Demographics
NPI:1922346576
Name:ROBERTS, AILEEN R (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:R
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 N EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5005
Mailing Address - Country:US
Mailing Address - Phone:208-939-6267
Mailing Address - Fax:208-938-1399
Practice Address - Street 1:3775 N EAGLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5005
Practice Address - Country:US
Practice Address - Phone:208-939-6267
Practice Address - Fax:208-938-1399
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC 4565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional