Provider Demographics
NPI:1992017313
Name:ROBERSON, AMETHYST
Entity type:Individual
Prefix:MRS
First Name:AMETHYST
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 N HIGHWAY 67 # 314
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-5904
Mailing Address - Country:US
Mailing Address - Phone:314-301-9100
Mailing Address - Fax:
Practice Address - Street 1:9666 OLIVE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3026
Practice Address - Country:US
Practice Address - Phone:314-301-9100
Practice Address - Fax:314-301-9122
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health