Healthcare Provider Details

I. General information

NPI: 1336847458
Provider Name (Legal Business Name): RYAN F.P. ROBERTSON M.S., ALPC-MHSP, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136A CAHAL AVE
NASHVILLE TN
37206-1610
US

IV. Provider business mailing address

1136A CAHAL AVE
NASHVILLE TN
37206-1610
US

V. Phone/Fax

Practice location:
  • Phone: 931-223-1095
  • Fax:
Mailing address:
  • Phone: 931-223-1095
  • Fax: 855-652-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-222937
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberY3C9X7P3
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7752
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number000-1960
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7752
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: