Provider Demographics
NPI:1265781470
Name:ROBERTS, W. RENEE (LMFT)
Entity type:Individual
Prefix:
First Name:W.
Middle Name:RENEE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 E MAIN ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2825
Mailing Address - Country:US
Mailing Address - Phone:317-640-5946
Mailing Address - Fax:
Practice Address - Street 1:2680 E MAIN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2825
Practice Address - Country:US
Practice Address - Phone:317-640-5946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001766A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist