Provider Demographics
NPI:1265550420
Name:ROBERSON, JAN C (LPCC)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:C
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 ROBERSON ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-3243
Mailing Address - Country:US
Mailing Address - Phone:270-759-1087
Mailing Address - Fax:
Practice Address - Street 1:103 W 11TH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-1445
Practice Address - Country:US
Practice Address - Phone:270-527-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional