Provider Demographics
NPI:1548300536
Name:ROBERTSON, JAMES MICHAEL (LMHC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7729 N 700 W
Mailing Address - Street 2:
Mailing Address - City:FAIRLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46126-9664
Mailing Address - Country:US
Mailing Address - Phone:317-835-7636
Mailing Address - Fax:
Practice Address - Street 1:1672N 600W
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-9626
Practice Address - Country:US
Practice Address - Phone:317-894-3280
Practice Address - Fax:317-894-3288
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000205A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN39000205AOtherLICENSED MENTAL HEALTH CO