MEDICARE: ROBERT M. SPERRY, PH.D., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	103T00000X	Psychologist
3	101YM0800X	Mental Health Counselor
4	103TS0200X	School Psychologist
5	1041C0700X	Clinical Social Worker
6	106H00000X	Marriage & Family Therapist
7	103TC0700X	Clinical Psychologist	23178	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558411744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT M. SPERRY, PH.D., INC.

Provider Business Mailing Address
First Line	:	PO BOX 2186
Second Line	:
City	:	FLINT
State	:	TX
Zip	:	75762-2186
Country	:	US
Telephone Number	:	903-534-5968
Fax Number	:

Provider Business Practice Location Address
First Line	:	3334 SSW LOOP 323
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-9237
Country	:	US
Telephone Number	:	903-534-5968
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. ROBERT SPERRY JR.
Credential	:	PH.D.
Telephone Number	:	903-534-5968

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	05/25/2021

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Directions to “ROBERT M. SPERRY, PH.D., INC. ” Practice Location

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