Provider Demographics
NPI:1487271607
Name:ROBERTS, JASON A (MS, LMHC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1345 KULEWA LOOP # 18A
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4373
Mailing Address - Country:US
Mailing Address - Phone:808-342-1508
Mailing Address - Fax:
Practice Address - Street 1:94-1345 KULEWA LOOP # 18A
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4373
Practice Address - Country:US
Practice Address - Phone:808-342-1508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILMHC176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health