| Doctor Name: | MARLO PATRICE ROBERTSON |
| NPI Number: | 1497182646 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | LMSW32615 |
| Business Practice Address: | 210 W Burnside Suite A Chubbuck, ID - 83202 |
| Business Phone Number: | 2082389000 |
| Business Fax Number: | |
| Mailing Address: | 210 W Burnside Ave Ste A, CHUBBUCK |
| State: | ID |
| Postal Code: | 832024916 |
| Phone Number: | 2082389000 |
| Fax Number: | |
| NPI Enumeration Date: | 10/02/2013 |
| NPI Last Update Date: | 10/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LMSW32615 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |