MEDICARE: DR. ROBERT L DEVEREAUX PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	3496	TN
2	103TC0700X	Clinical Psychologist	36518	TX

General Provider Information

NPI Number	:	1639487598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L DEVEREAUX PH.D.

Provider Business Mailing Address
First Line	:	9129 CROSS PARK DR STE 100
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4505
Country	:	US
Telephone Number	:	865-983-1899
Fax Number	:	865-409-5948

Provider Business Practice Location Address
First Line	:	9129 CROSS PARK DR STE 100
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4505
Country	:	US
Telephone Number	:	865-983-1899
Fax Number	:	865-409-5948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	03/05/2025

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