Provider Demographics
NPI:1477196087
Name:ROBERTS, LYNETTE (CADC1, CRM, PSS,QMHA)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CADC1, CRM, PSS,QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4646
Mailing Address - Country:US
Mailing Address - Phone:541-617-7365
Mailing Address - Fax:541-312-6343
Practice Address - Street 1:908 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4646
Practice Address - Country:US
Practice Address - Phone:541-617-7365
Practice Address - Fax:541-312-6343
Is Sole Proprietor?:No
Enumeration Date:2019-10-26
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-QMHA-R-3797101YM0800X
OR18-CRM-371175T00000X
OR210710194101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist