Healthcare Provider Details

I. General information

NPI: 1053181032
Provider Name (Legal Business Name): RL ROBERTS MS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 S FLEISHEL AVE
TYLER TX
75701-2012
US

IV. Provider business mailing address

1201 S FLEISHEL AVE
TYLER TX
75701
US

V. Phone/Fax

Practice location:
  • Phone: 903-581-0933
  • Fax: 903-581-3977
Mailing address:
  • Phone: 903-581-0933
  • Fax: 903-581-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. RON L ROBERTS
Title or Position: OWNER
Credential: MS
Phone: 903-581-0933