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General NPI Number Information
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NPI Number | 1154678241
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Entity Type | Organization
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Legal Business Name | SAMUEL J. ROBERTS AND ASSOCIATES
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 206 E COLLEGE ST STE A-100
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City | GRAPEVINE
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State | TX
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Zip | 76051-5364
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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 |
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Fax | 817-424-1766
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SAMUEL JOSEPH ROBERTS
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Credential | PH.D.
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Telephone | 817-424-5157
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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 |
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License Number State |
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