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General NPI Number Information
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NPI Number | 1174635379
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Entity Type | Individual
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Provider Name | RON L ROBERTS MS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 606 S FLEISHEL AVE
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City | TYLER
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State | TX
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Zip | 75701-2012
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Country | US
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Telephone | 903-581-0933
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Fax | 903-581-3977
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Provider Business Mailing Address
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Address Line | 606 S FLEISHEL AVE STE 204
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City | TYLER
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State | TX
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Zip | 75701-2012
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Country | US
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Telephone | 903-581-0933
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Fax | 903-581-3977
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 14775
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 15103
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License Number State | TX
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