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Individual

KEVIN ROBERTSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PLPC

Contact information

Practice address
318 N MAIN ST, MARYVILLE, MO 64468-1644
(660) 562-3000
(660) 562-3002
Mailing address
721 W EDWARDS ST, MARYVILLE, MO 64468-2127
(660) 562-3000
(660) 562-3002

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
5019251006
MO
101YP2500X
Professional Counselor
Primary
5019251006
MO

Other

Enumeration date
06/19/2015
Last updated
06/19/2015
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