Provider Demographics
NPI:1366754483
Name:MOLSTAD, ROBERTA LYNN (MS, LPC)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:LYNN
Last Name:MOLSTAD
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 7TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4161
Mailing Address - Country:US
Mailing Address - Phone:785-432-1805
Mailing Address - Fax:785-301-2325
Practice Address - Street 1:205 E 7TH ST STE 106
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4161
Practice Address - Country:US
Practice Address - Phone:785-432-1805
Practice Address - Fax:785-301-2325
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200664340AMedicaid