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General NPI Number Information
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NPI Number | 1114041340
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Entity Type | Individual
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Provider Name | SAMUEL J ROBERTS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/14/2018
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Provider Practice Location Address
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Address Line | 601 S MAIN ST STE 216
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City | GRAPEVINE
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State | TX
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Zip | 76051-5385
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Country | US
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Telephone | 817-424-5157
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Fax | 817-424-1766
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Provider Business Mailing Address
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Address Line | PO BOX 38326
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City | DALLAS
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State | TX
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Zip | 75238-0326
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Country | US
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Telephone | 214-341-3822
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Fax | 817-424-1766
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 23376
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License Number State | TX
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