Provider Demographics
NPI:1982938254
Name:TABER, ROBERTA J (LLPC, HHC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:J
Last Name:TABER
Suffix:
Gender:F
Credentials:LLPC, HHC
Other - Prefix:
Other - First Name:BOBBE
Other - Middle Name:
Other - Last Name:TABER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5518 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1211
Mailing Address - Country:US
Mailing Address - Phone:269-492-4488
Mailing Address - Fax:
Practice Address - Street 1:320 LIBRARY LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4303
Practice Address - Country:US
Practice Address - Phone:269-329-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-19
Last Update Date:2009-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008450101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional