Provider Demographics
NPI:1457133514
Name:ROBERTS, KYRSTEN
Entity Type:Individual
Prefix:MISS
First Name:KYRSTEN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12305 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4915
Mailing Address - Country:US
Mailing Address - Phone:971-701-5270
Mailing Address - Fax:
Practice Address - Street 1:13590 NW MAIN ST
Practice Address - Street 2:
Practice Address - City:BANKS
Practice Address - State:OR
Practice Address - Zip Code:97106-9057
Practice Address - Country:US
Practice Address - Phone:503-298-6562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health