Healthcare Provider Details

I. General information

NPI: 1861406068
Provider Name (Legal Business Name): ELEANOR TERHUNE ROBERTSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13791 BLUFF VILLAS CT
SAN ANTONIO TX
78216-1941
US

IV. Provider business mailing address

13791 BLUFF VILLAS CT
SAN ANTONIO TX
78216-1941
US

V. Phone/Fax

Practice location:
  • Phone: 210-491-4415
  • Fax:
Mailing address:
  • Phone: 210-491-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2-1943
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: