Provider Demographics
NPI:1366724221
Name:ROBERTSON WEBER, TRICIA (LPC)
Entity type:Individual
Prefix:MS
First Name:TRICIA
Middle Name:
Last Name:ROBERTSON WEBER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 S YUKON PKWY STE A&B
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4596
Mailing Address - Country:US
Mailing Address - Phone:405-810-0054
Mailing Address - Fax:405-810-8977
Practice Address - Street 1:373 S YUKON PKWY STE A&B
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4596
Practice Address - Country:US
Practice Address - Phone:405-810-0054
Practice Address - Fax:405-810-8977
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3676101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3676OtherOKLAHOMA STATE DEPARTMENT OF HEALTH