Healthcare Provider Details

I. General information

NPI: 1639487598
Provider Name (Legal Business Name): ROBERT L DEVEREAUX PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9129 CROSS PARK DR STE 100
KNOXVILLE TN
37923-4505
US

IV. Provider business mailing address

9129 CROSS PARK DR STE 100
KNOXVILLE TN
37923-4505
US

V. Phone/Fax

Practice location:
  • Phone: 865-983-1899
  • Fax: 865-409-5948
Mailing address:
  • Phone: 865-983-1899
  • Fax: 865-409-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3496
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: