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General NPI Number Information
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NPI Number | 1144614264
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Entity Type | Organization
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Legal Business Name | ROBERSON CLINICAL SERVICES, LLC
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 11024 N 28TH DR SUITE 290
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City | PHOENIX
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State | AZ
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Zip | 85029-4377
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Country | US
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Telephone | 623-486-0935
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Fax | 602-734-0692
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Provider Business Mailing Address
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Address Line | 11024 N 28TH DR SUITE 290
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City | PHOENIX
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State | AZ
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Zip | 85029-4377
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Country | US
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Telephone | 623-486-0935
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Fax | 602-734-0692
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. JOSEPH CHARLES ROBERSON
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Credential | PH.D.
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Telephone | 623-486-0935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1843
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License Number State | AZ
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