Provider Demographics
NPI:1063232247
Name:ROBERTS, MISTY DAWN (LPC ASSOCIATE, NCC)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPC ASSOCIATE, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6419
Mailing Address - Country:US
Mailing Address - Phone:682-719-2582
Mailing Address - Fax:
Practice Address - Street 1:1715 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6419
Practice Address - Country:US
Practice Address - Phone:682-719-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health