Healthcare Provider Details

I. General information

NPI: 1821603390
Provider Name (Legal Business Name): ALLISON A ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 MIDWAY RD
DALLAS TX
75209-2835
US

IV. Provider business mailing address

135 PINELAWN RD STE 204N
MELVILLE NY
11747-3133
US

V. Phone/Fax

Practice location:
  • Phone: 832-725-5934
  • Fax:
Mailing address:
  • Phone: 844-888-0355
  • Fax: 844-222-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number149.022484
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103661
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: