Provider Demographics
NPI:1154678241
Name:SAMUEL J. ROBERTS AND ASSOCIATES
Entity Type:Organization
Organization Name:SAMUEL J. ROBERTS AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-424-5157
Mailing Address - Street 1:PO BOX 38326
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-0326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:817-424-1766
Practice Address - Street 1:206 E COLLEGE ST
Practice Address - Street 2:STE A-100
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5364
Practice Address - Country:US
Practice Address - Phone:817-424-5157
Practice Address - Fax:817-424-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR57215Medicare UPIN
TX00DC57Medicare PIN