Healthcare Provider Details

I. General information

NPI: 1215338405
Provider Name (Legal Business Name): ROBERT ROUAULT PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 SALTON LN STE 100
THOMPSONS STATION TN
37179-2225
US

IV. Provider business mailing address

25550 HAWTHORNE BLVD STE 316
TORRANCE CA
90505-6832
US

V. Phone/Fax

Practice location:
  • Phone: 615-909-4469
  • Fax:
Mailing address:
  • Phone: 424-262-6059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4146
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY31401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: