Provider Demographics
NPI:1851821573
Name:ROBERTS, OLGA IMELDA (LMFT)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:IMELDA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19216 TRAILVIEW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4027
Mailing Address - Country:US
Mailing Address - Phone:210-383-7780
Mailing Address - Fax:210-569-6367
Practice Address - Street 1:12915 JONES MALTSBERGER RD STE 425
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4256
Practice Address - Country:US
Practice Address - Phone:210-383-7780
Practice Address - Fax:210-569-6367
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202503106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202503OtherTEXAS STATE LICENSE