Individual
MARLO PATRICE ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
645 W CLARK ST, POCATELLO, ID 83204-3141
(208) 234-9361
Mailing address
210 W BURNSIDE AVE STE A, CHUBBUCK, ID 83202-4916
(208) 238-9000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LMSW32615
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-37020
ID
Other
Enumeration date
10/02/2013
Last updated
06/13/2022
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