Provider Demographics
NPI:1396147070
Name:HARPER-MCINTOSH, ROBERTA (LPC)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:HARPER-MCINTOSH
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:PO BOX 1452
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82073-1452
Mailing Address - Country:US
Mailing Address - Phone:307-460-2795
Mailing Address - Fax:
Practice Address - Street 1:515 E IVINSON AVE STE 107
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3105
Practice Address - Country:US
Practice Address - Phone:307-460-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health