Healthcare Provider Details

I. General information

NPI: 1144626599
Provider Name (Legal Business Name): ROBERSON COUNSELING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 NORTH LAMAR BLVD SUITE 206
AUSTIN TX
78752-1022
US

IV. Provider business mailing address

PO BOX 660253
AUSTIN TX
78766-7253
US

V. Phone/Fax

Practice location:
  • Phone: 512-496-7724
  • Fax:
Mailing address:
  • Phone: 512-496-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH HART ROBERSON
Title or Position: MANAGER
Credential: LPC
Phone: 512-496-7724