Provider Demographics
NPI:1194085944
Name:ROBERTSON, KATHY A
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:A
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:3784 KINDLE LN
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-9102
Mailing Address - Country:US
Mailing Address - Phone:405-204-3207
Mailing Address - Fax:
Practice Address - Street 1:2316 N INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2942
Practice Address - Country:US
Practice Address - Phone:405-801-2817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health