Provider Demographics
NPI:1144611088
Name:ROBERSON, ROSE (LMHC)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-0423
Mailing Address - Country:US
Mailing Address - Phone:509-249-0120
Mailing Address - Fax:
Practice Address - Street 1:3601 W WASHINGTON AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-1164
Practice Address - Country:US
Practice Address - Phone:509-249-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health