Healthcare Provider Details

I. General information

NPI: 1336207331
Provider Name (Legal Business Name): VALERIE ANN ROBERTSON L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 LYNDALE ST
VIDOR TX
77662-5208
US

IV. Provider business mailing address

745 LYNDALE ST
VIDOR TX
77662-5208
US

V. Phone/Fax

Practice location:
  • Phone: 409-769-3191
  • Fax:
Mailing address:
  • Phone: 409-769-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13729
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: