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General NPI Number Information
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NPI Number | 1558518159
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Entity Type | Organization
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Legal Business Name | ROBERTA TSUKAHARA, PHD, PA
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 503 W 38TH ST
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City | AUSTIN
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State | TX
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Zip | 78705-1319
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Country | US
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Telephone | 512-459-5999
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Fax | 512-459-6001
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Provider Business Mailing Address
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Address Line | 503 W 38TH ST
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City | AUSTIN
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State | TX
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Zip | 78705-1319
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Country | US
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Telephone | 512-459-5999
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Fax | 512-459-6001
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ROBERTA TSUKARAHRA
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Credential | PHD
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Telephone | 512-459-5999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 31567
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License Number State | TX
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